Can we predict expected adenoma weight preoperatively with reference to the correlation of preoperative biochemical tests with parathyroid adenoma weight?

Leong, David; Lo, Johnny; Nguyen, Hieu; Ryan, Simon

doi:10.1016/j.asjsur.2019.10.004

Cited by 8 publications

(7 citation statements)

References 11 publications

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“…Leong et al published a retrospective study between 2013 and 2018 of 555 patients (a mean PTA weight of 1.022 g) and found a strong positive correlation between preoperative PTH levels and parathyroid weight (r=0.602, P<0.001), a medium correlation between calcium before surgery and parathyroid gland (r=0.474, P<0.001). Thus, PTH appears to be a better predictor of PTA weight than calcemic levels (11). Another cohort of 378 cases presenting with PHPT found a statistically significant correlation of preoperative calcium, respective PTH values and adenoma dimensions and weight.…”

Section: Pre-operative Biological Correlatesmentioning

confidence: 93%

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Primary hyperparathyroidism-related giant parathyroid adenoma (Review)

et al. 2021

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Primary hyperparathyroidism (PHPT), an endocrine condition caused by a parathyroid adenoma (PTA) in 80-85% of the cases, has shifted in the modern era to a mildly symptomatic phenotype due to the prompt recognition of hypercalcemia and to a minimally invasive surgical approach which has a curative potential. Clinical complications of PHTH are either related to high calcium or parathyroid hormone [also parathormone (PTH)] or both, while the originating tumor typically is small, without local mass effects. A distinct entity is represented by giant PTA (GPTA) which is considered at a weight of more than 3 (3.5) grams. The present article is a review of the literature involving practical points of non-syndromic PHPT-related GPTA. Most authors agree that pre-operatory calcium and PTH are higher in GPTA vs. non-GPTA. However, the clinical presentation of PHPT may be less severe, probably due to local mass effects that bring the patient to an early medical evaluation. Age distribution, sex ratio, rate of successful pre-operatory location do not differ from non-giant PTA. Hypovitaminosis D is more frequent in PTA of higher dimensions. Post-operative hypocalcemia, but not recurrent/persistent PHPT, is expected, even hungry bone disease. A higher rate of atypia is described although the tumor is mostly benign. Unusual presentations such as cystic transformation, initial diagnosis during pregnancy or auto-infarction have been reported. The ectopic localization of PTA presented in almost 15% of all cases may also be found in GPTA. What are the exact cutoffs for defining GPTA is still an open issue. Contents 1. Introduction 2. Aim 3. Giant parathyroid adenoma: Concept around the size considerations 4. Pre-operative biological correlates 5. Relationship with vitamin D status 6. Histological issues 7. Ectopic PTA of large dimensions 8. Risk of post-operative hypocalcemia 9. Future considerations 10. Conclusions

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Section: Pre-operative Biological Correlatesmentioning

confidence: 93%

“…Table I introduces the review of the literature of cases/studies identified between 2010 and 2020 available via PubMed in the field of HPTH-related GPTA (11,(13)(14)(15)(16)18,19,21,23,25,27,29,30,(32)(33)(34)(36)(37)(38)(39)(40)(41)43,.…”

Section: Future Considerationsmentioning

confidence: 99%

Primary hyperparathyroidism-related giant parathyroid adenoma (Review)

et al. 2021

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“…Описаны случаи с расположением позади пищевода, в тимусе, рудиментарном аортопульмональном окне, средостении и щитовидной железе [17]. Масса аденомы колеблется от 300 мг до нескольких граммов, а размеры варьируются от нескольких миллиметров до 10 см [18]. Макроскопически аденома выглядит как хорошо очерченный, гладкий, красно-коричневый узелок, иногда он инкапсулирован.…”

Section: аденома ощжunclassified

Main parathyroid tumors

et al. 2023

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Primary hyperparathyroidism is the third most common disease of the endocrine system. It is characterized by an increase in parathyroid hormone, hypercalcemia, hypercalciuria, hypophosphatemia. Symptoms include polyuria, bone pain, weakness, and constipation. In most cases, primary hyperparathyroidism is caused by solitary parathyroid adenoma — 85%. Other causes include hyperplasia (5%), multiple adenomas (<5%), and cancer (<1%). However, particular attention in this article is paid to two causes of primary hyperparathyroidism: parathyroid adenoma and cancer, as they are of high interest both from a molecular point of view and from the clinical features of these tumors. In addition, these tumors overlap in their symptoms and signs and the diagnosis is often made only after histological examination. In total, we identified 2700 articles, of which 66 met the inclusion criteria. The 66 included studies were topical for tumor lesions of the parathyroid gland. They were held between 1997 and 2022. This review emphasizes the importance of further research of the molecular features of these diseases and, possibly, targeted treatment options, since, for example, in cancer, even with R0 resection, the risk of recurrence is high. The article also focuses on the issues of the new World Health Organization 2022 classification of tumor lesions of the parathyroid gland, which is also important for a unified study of these tumors.

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“…Intraoperative diagnosis was prompted by intraoperative PTH monitoring (IOPTH) in 38.5%, surgeon interpretation of imaging in 38.1%, observing ipsilateral gland enlargement in 11.0%, by finding an initial gland <200 mg in 10.3% and 2.0% had unexpected MGPD during thyroidectomy [ 63 ]. In addition, there is a positive correlation between preoperative PTH levels and parathyroid gland weight for single gland disease [ 16 ]. However, there is a high degree of variability in parathyroid gland size and it alone is not a reliable indicator of adenoma or MGPD [ 16 , 49 ].…”

Section: Surgical Considerationsmentioning

confidence: 99%

“…In addition, there is a positive correlation between preoperative PTH levels and parathyroid gland weight for single gland disease [ 16 ]. However, there is a high degree of variability in parathyroid gland size and it alone is not a reliable indicator of adenoma or MGPD [ 16 , 49 ].…”

Section: Surgical Considerationsmentioning

confidence: 99%

A contemporary analysis of the pre- and intraoperative recognition of multigland parathyroid disease

Lawrence,

Johri,

Dave

et al. 2023

Langenbecks Arch Surg

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Background Despite advances in biochemical and radiological identification of parathyroid gland enlargement, primary hyperparathyroidism (PHPT) due to sporadic multigland parathyroid disease (MGPD) remains a perioperative diagnostic dilemma. Failure to recognise MGPD pre- or intraoperatively may negatively impact surgical cure rates and result in persistent PHPT and ongoing patient morbidity. Methods We have conducted a comprehensive review of published literature in attempt to determine factors that could aid in reliably diagnosing sporadic MGPD pre- or intraoperatively. We discuss preoperative clinical features and examine pre- and intraoperative biochemical and imaging findings concentrating on those areas that give practicing surgeons and the wider multi-disciplinary endocrine team indications that a patient has MGDP. This could alter surgical strategy. Conclusion Biochemistry can provide diagnosis of PHPT but cannot reliably discriminate parathyroid pathology. Histopathology can aid diagnosis between MGPD and adenoma, but histological appearance can overlap. Multiple negative imaging modalities indicate that MGPD may be more likely than a single parathyroid adenoma, but the gold standard for diagnosis is still intraoperative identification during BNE. MGPD remains a difficult disease to both diagnose and treat.

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Can we predict expected adenoma weight preoperatively with reference to the correlation of preoperative biochemical tests with parathyroid adenoma weight?

Cited by 8 publications

References 11 publications

Primary hyperparathyroidism-related giant parathyroid adenoma (Review)

Primary hyperparathyroidism-related giant parathyroid adenoma (Review)

Main parathyroid tumors

A contemporary analysis of the pre- and intraoperative recognition of multigland parathyroid disease

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