Giant Parathyroid Adenoma: Are They Different?

Grover, Mohnish; Sharma, Monika; Bhandari, Sudhir; Sharma, Balram; Bhargva, Shruti; Samdhani, Sunil

doi:10.1007/s12070-020-01898-7

Cited by 2 publications

(3 citation statements)

References 9 publications

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“…Postoperative management consists of prophylaxis of "hungry bones syndrome" with calcium supplementation, as this is the most frequent complication after resection of a parathyroid adenoma due to transient hypocalcemia. Patients usually recover with no long-term complications or recurrence [4][5][6][7].…”

Section: Discussionmentioning

confidence: 99%

Giant Parathyroid Adenoma: A Case of Primary Hyperparathyroidism

N¹,

Julia²,

Sylvia³

2021

J Surgical Endocrinol

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Introduction:We report an adult male with the sole condition of recurrent nephrolithiasis, with no other associated symptoms nor family history, who was later diagnosed with Primary Hyperparathyroidism due to a giant right superior parathyroid adenoma. To the best of our knowledge, this is one of the few well-documented cases of this rare presentation in a male patient of the Dominican Republic. This case should affect the practice of physicians who interact with primary hyperparathyroidism and are involved in their management.Case presentation: A 55-year-old hispanic man who was diagnosed and treated for the last 8 years for recurrent calcium nephrolithiasis with no other associated symptoms. Etiology for his condition remained unknown to the patient until he visited a tertiary care level hospital for routine check-up, where he was referred to endocrinology due to incidental biochemical findings of elevated PTH levels (718.10 pg/ml), hypercalcemia (13.27 mg/dl), elevated ALP (386.90 U/L), 24 hr urinary calcium of 483.04 mg/24 hr, and hypophosphatemia (2.03 mg/dl). Other symptoms common to PHPT such as abdominal pain, fatigue, weakness, psychiatric disturbances such as depression, or numbness of the skin were denied by the patient. Family history was negative for thyroid, parathyroid or kidney disease. The patient works frequently outdoors and is constantly exposed to the sun. The patient underwent a standard Tc99m-sestamibi scan that revealed heterogenous delayed persistent tracer localization in the right upper parathyroid region. An ultrasound of the neck was performed which revealed a right superior mass of the parathyroid gland measuring 4.00 × 2.48 × 2.02 cm (700% increase in size) and weighting 10.6 gm. Conclusion: Giant parathyroid adenomas are rarely encountered among patients with primary hyperparathyroidism and are known to present with distinct clinical and biochemical features that differ from typical parathyroid adenomas. To the best of our knowledge, this case report describes the first case reported in the Dominican Republic of a patient with Giant Parathyroid Adenoma (GPTA). This case report also reviews the published literature to report on the clinical characteristics and typical presentation of GPTA as well as diagnosis and treatment.

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Section: Discussionmentioning

confidence: 99%

Giant Parathyroid Adenoma: A Case of Primary Hyperparathyroidism

N¹,

Julia²,

Sylvia³

2021

J Surgical Endocrinol

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“…During 40 months of post-operative follow-up, none of the GPTA cases had recurrent disease; the fact that the tumor was large did not underline a malignancy (14). Grover et al published a study in 2020 of 79 patients with PHPT and PTA; 11.3% of them had a giant tumor (maximum diameter between 3.5 and 5.5 cm) without pre-operative correlations in biochemical elements and adenoma size (15). Another potential useful correlation was described in one study between neutrophil/lymphocyte ratio and PTA size (a study on 32 parathyroid tumors, mean age of 53 years, 75% of them were females) (16).…”

Section: Pre-operative Biological Correlatesmentioning

confidence: 99%

“…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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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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Giant Parathyroid Adenoma: Are They Different?

Cited by 2 publications

References 9 publications

Giant Parathyroid Adenoma: A Case of Primary Hyperparathyroidism

Giant Parathyroid Adenoma: A Case of Primary Hyperparathyroidism

Primary hyperparathyroidism-related giant parathyroid adenoma (Review)

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