Primary hyperparathyroidism-related giant parathyroid adenoma (Review)

Abstract

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

An Atypical Presentation of Primary Hyperparathyroidism With Multiple Spontaneous Tendon Ruptures: A Case Report and Literature Review on the Management of Primary Hyperparathyroidism

“…Postoperatively, he was confirmed to have a large right inferior parathyroid adenoma weighing 4.4 g. In literature, parathyroid adenomas >3.5 g have been associated with higher preoperative PTH and calcium levels as well as a greater risk for postoperative hypocalcemia. 12 A recent dual-center study from Singapore on 164 patients with PHPT who underwent parathyroidectomy showed median preoperative iPTH of 18.8 pmol/L, median corrected calcium of 2.7 mmol/L, median serum 25-hydroxyvitamin D of 20 ng/mL and median adenoma volume of 1 cm 3 . The study showed significant correlation between adenoma volume and preoperative iPTH levels and demonstrated that the pre-operative iPTH and ALP levels were significantly associated with the risk of developing HBS.…”

“…Postoperatively, he was confirmed to have a large right inferior parathyroid adenoma weighing 4.4 g. In literature, parathyroid adenomas >3.5 g have been associated with higher preoperative PTH and calcium levels as well as a greater risk for postoperative hypocalcemia. 12 www.asean-endocrinejournal.org Jielin Yew and Shui Boon Soh PHPT With Multiple Spontaneous Tendon Ruptures Although the risk of recurrence is greater in those with hereditary PHPT, these studies suggest that recurrence is not uncommon in sporadic PHPT and can still occur several years after curative parathyroidectomy.…”

Acute presentation of giant parathyroid adenoma extending to the mediastinum: A case report

“…Pre-operative localization of the adenoma is essential before surgery. Several diagnostic localization methods include parathyroid scintigraphy, ultrasound, CT scans, parathyroid scintigraphy and PET scanning [2] .…”

“…Primary hyperparathyroidism is the third most common endocrine disorder after diabetes and thyroid diseases [1] , [2] . It is caused in 85 % of cases by a solitary parathyroid adenoma.…”

Preoperative biochemical values are correlated with adenoma volume, but not predictive factors for hungry bone syndrome in patients with primary hyperparathyroidism

“…In our study, we found that the excised parathyroid volume was moderately correlated with preoperative calcium and PTH levels. A large-series study showed a moderate correlation between adenoma weight and preoperative PTH levels [18,19].…”