Double adenomas revisited: Nonuniform distribution favors enlarged superior parathyroids (fourth pouch disease)

Milas, Mira; Wagner, Kristin; Easley, Kirk A.; Siperstein, Allan; Weber, Collin J.

doi:10.1016/j.surg.2003.07.009

Cited by 77 publications

(45 citation statements)

References 19 publications

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“…The latter corresponds to previous reports [1,4,10,11]. Our results also confirmed that DA can more frequently be found in atypical localizations.…”

Section: Author Contributionssupporting

confidence: 93%

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One hundred double adenomas in primary hyperparathyroidism

et al. 2013

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One hundred double adenomas in primary hyperparathyroidism 295 1 3 SummaryBackground Double adenomas (DAs) occur in 2-15 % of primary hyperparathyroidism (pHPT) patients. To date, the existence of this distinct entity remains controversial. The aim of this study was to evaluate the clinical characteristics and anatomic distribution of DAs to identify anatomic patterns and implications for surgical management.Methods We reviewed prospective database records of 1,464 unselected, consecutive patients who were treated for pHPT in our institution between 1986 and 2012. We identified 100 DA patients (6.8 %) and compared their clinical characteristics with those of solitary adenomas (SAs; n = 1,226) and hyperplasia (including multiple endocrine neoplasia; n = 101).Results A total of 74 % of our patient collective was female. DAs were predominantly located on the right side (30 %) or crossed (23 %) and demonstrated an increased incidence of atypical position (38 %). Patients with DA showed significantly more neuropsychiatric disorders and pancreatitis compared with those in the other groups. Our results revealed higher parathyroid hormone levels in patients with DA compared with those with SA or hyperplasia. In 74 patients, the DA was primarily found, whereas 26 patients needed reoperation. Only nine DAs had developed metachronously. The overall cure rate of all patients with pHPT was 96.4 % (carcinomas excluded).Conclusions DAs are a distinct entity and show no specific characteristic features that could facilitate easy detection. The chance of a metachronous appearance is statistically low, but has significant clinical impact as a major cause for late recurrence of hyperparathyroidism and need for reoperation.Keywords Double adenoma · Primary hyperparathyroidism · Hyperplasia · Hypercalcemia Abbreviations DA double adenoma IOPTH intraoperative parathyroid hormone assay MEN multiple endocrine neoplasia PTH parathyroid hormone pHPT primary hyperparathyroidism SA single adenomaThe first two authors contributed equally to this work.

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“…The latter corresponds to previous reports [1,4,10,11]. Our results also confirmed that DA can more frequently be found in atypical localizations.…”

Section: Author Contributionssupporting

confidence: 93%

“…DAs have been reported to occur in 2-15 % of patients with pHPT [3][4][5][6][7][8][9][10][11][12][13], and have been first described by Mandl in 1947 [14].…”

Section: Introductionmentioning

confidence: 99%

One hundred double adenomas in primary hyperparathyroidism

et al. 2013

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“…15 The average weight of adenomas in patients without significant bone disease is B1 g with many o0.5 g, whereas tumors in patients with significant bone disease tend to be larger. The term 'microadenoma' refers to tumors weighing o0.1 g. Foci of cystic change tend to occur in large adenomas and are relatively common in the tumors associated with the hyperparathyroidism-jaw tumor (HPT-JT) syndrome, as discussed in a subsequent section.…”

Section: Parathyroid Adenomamentioning

confidence: 99%

Parathyroid tumors and related disorders

2011

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Primary hyperparathyroidism (P-HPT) is a common endocrine disorder that occurs as a result of adenomas (80-85%), hyperplasias (10-15%) or carcinomas (o1%) of the parathyroid glands. Molecular genetic analyses of heritable P-HPT syndromes have provided considerable insight into the understanding of sporadic parathyroid tumors and hyperplasias. This review will focus on the criteria for classification of parathyroid proliferative disorders and will highlight our understanding of these lesions at the molecular level. Advances in radiological imaging techniques together with the rapid intraoperative parathyroid hormone assay will be reviewed with respect to current treatment approaches for P-HPT.

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“…False declines are probably rare if patients have been properly selected for focused parathyroidectomy but still occur in 1-3% of cases [6,30,31]. In a series of bilateral explorations validating intraoperative PTH testing, some 50-75% of patients with multiglandular disease have shown an inappropriate 50% drop of PTH values [31][32][33][34][35][36]. This may be due to the initial removal of the most active gland (which, in addition, may be the only one showing on the scan) or to latent multiple endocrine neoplasia type 1 disease [31,32].…”

Section: Intraoperative Pth Measurementsmentioning

confidence: 99%

Surgery for sporadic primary hyperparathyroidism: controversies and evidence-based approach

Sitges‐Serra

Prieto

Valero

et al. 2008

Langenbecks Arch Surg

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Surgery should never be indicated on the basis of positive or negative preoperative localization studies. Intraoperative quick parathyroid hormone measurements seem particularly helpful for cases with equivocal localization studies. The best minimal access approach is still a matter of debate, and options include small central incision, video-assisted parathyroidectomy, minimal lateral open approach, and purely endoscopic access via lateral approach. Radioguided surgery does not seem to have a role in routine cases but may be useful to find adenomas during reintervention on scarred difficult surgical fields.

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Double adenomas revisited: Nonuniform distribution favors enlarged superior parathyroids (fourth pouch disease)

Cited by 77 publications

References 19 publications

One hundred double adenomas in primary hyperparathyroidism

One hundred double adenomas in primary hyperparathyroidism

Parathyroid tumors and related disorders

Surgery for sporadic primary hyperparathyroidism: controversies and evidence-based approach

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