Primary Hyperparathyroidism: Role of the Preoperative Oral Calcium Loading Test in the Differential Diagnosis Between Adenoma and Hyperplasia

Hagag, Philippe; Kummer, Esther; Weiss, Meital

doi:10.1007/s00223-008-9191-9

Cited by 8 publications

(11 citation statements)

References 36 publications

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“…PTH decline >60 % diagnosed hyperplasia with specificity of 100 %. The total accuracy of the test was 65 % [ 66 ]. This model has not been confirmed by other groups.…”

Section: Preoperative Diagnosis Of Sporadic Multiglandular Diseasementioning

confidence: 99%

Sporadic multiple parathyroid gland disease—a consensus report of the European Society of Endocrine Surgeons (ESES)

Barczyński

Bränström

Dionigi

et al. 2015

Langenbecks Arch Surg

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BackgroundSporadic multiglandular disease (MGD) has been reported in literature in 8–33 % of patients with primary hyperparathyroidism (pHPT). This paper aimed to review controversies in the pathogenesis and management of sporadic MGD.MethodsA literature search and review was made to evaluate the level of evidence concerning diagnosis and management of sporadic MGD according to criteria proposed by Sackett, with recommendation grading by Heinrich et al. and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Results were discussed at the 6th Workshop of the European Society of Endocrine Surgeons entitled ‘Hyperparathyroidism due to multiple gland disease: An evidence-based perspective’.ResultsLiterature reports no prospective randomised studies; thus, a relatively low level of evidence was achieved. Appropriate surgical therapy of sporadic MGD should consist of a bilateral approach in most patients. Unilateral neck exploration guided by preoperative imaging should be reserved for selected patients, performed by an experienced endocrine surgeon and monitored by intraoperative parathormone assay (levels of evidence III–V, grade C recommendation). There is conflicting or equally weighted levels IV–V evidence supporting that cure rates can be similar or worse for sporadic MGD than for single adenomas (no recommendation). Best outcomes can be expected if surgery is performed by an experienced parathyroid surgeon working in a high-volume centre (grade C recommendation). Levels IV–V evidence supports that recurrent/persistence pHPT occurs more frequently in patients with double adenomas hence in situations where a double adenoma has been identified, the surgeon should have a high index of suspicion during surgery and postoperatively for the possibility of a four-gland disease (grade C recommendation).ConclusionsIdentifying preoperatively patients at risk for MGD remains challenging, intraoperative decisions are important for achieving acceptable cure rates and long-term follow-up is mandatory in such patients.

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“…PTH decline >60 % diagnosed hyperplasia with specificity of 100 %. The total accuracy of the test was 65 % [ 66 ]. This model has not been confirmed by other groups.…”

Section: Preoperative Diagnosis Of Sporadic Multiglandular Diseasementioning

confidence: 99%

Sporadic multiple parathyroid gland disease—a consensus report of the European Society of Endocrine Surgeons (ESES)

Barczyński

Bränström

Dionigi

et al. 2015

Langenbecks Arch Surg

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“…Robert et all suggested that PTH level <4 times the upper limit of normal excludes malignancy [19]. Case series studying solitary parathyroid adenomas with asymptomatic disease derived mean preoperative PTH levels of 186 pg/mL [20] and 165 pg/mL [21], while research studying parathyroid carcinoma yielded higher PTH levels of 714 pg/mL [22] and 1220 pg/mL [23]. The huge size of the cystic adenoma (11 x 7 x 6 cm) in our case is extremely rare [3], though giant parathyroid cysts of up to 15 cm in diameter have also been reported [24].…”

Section: Discussionmentioning

confidence: 99%

A case report: Giant cystic parathyroid adenoma presenting with parathyroid crisis after Vitamin D replacement

2012

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BackgroundParathyroid adenoma with cystic degeneration is a rare cause of primary hyperparathyroidism. The clinical and biochemical presentation may mimic parathyroid carcinoma.Case presentationWe report the case of a 55 year old lady, who had longstanding history of depression and acid peptic disease. Serum calcium eight months prior to presentation was slightly high, but she was never worked up. She was found to be Vitamin D deficient while being investigated for generalized body aches. A month after she was replaced with Vitamin D, she presented to us with parathyroid crisis. Her corrected serum calcium was 23.0 mg/dL. She had severe gastrointestinal symptoms and acute kidney injury. She had unexplained consistent hypokalemia until surgery. Neck ultrasound and CT scan revealed giant parathyroid cyst extending into the mediastinum. After initial medical management for parathyroid crisis, parathyroid cystic adenoma was surgically excised. Her serum calcium, intact parathyroid hormone, creatinine and potassium levels normalized after surgery.ConclusionThis case of parathyroid crisis, with very high serum calcium and parathyroid hormone levels, is a rare presentation of parathyroid adenoma with cystic degeneration. This case also highlights that Vitamin D replacement may unmask subclinical hyperparathyroidism. Consistent hypokalemia until surgery merits research into its association with hypercalcemia.

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“…To further stress the benefit of PTH in preoperative diagnosis, Robert et al suggested that a PTH level <4 times the upper limit of normal excludes a malignancy [4]. Other studies support the above trend—a recent case series looking at solitary adenomas causing asymptomatic disease have derived mean values of Preoperative PTH as 186 [5] and 165 ng/L [6], while research into carcinoma show higher PTH levels of 714 [2] and 1220 ng/L [7]. This consolidates the unusual nature of a PTH level of 3957 ng/L in an adenoma with no radiological, Intraoperative, or histological evidence of malignancy.…”

Section: Discussionmentioning

confidence: 99%

A Parathyroid Adenoma: Benign Disease Presenting with Hyperparathyroid Crisis

Tahim

Saunders

Sinha

2010

Case Reports in Medicine

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Hyperparathyroid crisis is a rare manifestation of parathyroid disease. We present the case of a 53-year-old gentleman with a review of the current literature. He presented in acute renal failure with epigastric pain and vomiting. His serum-corrected calcium (CCa2+) was raised at 5.2 mmol/L, in addition to a massively raised parathyroid hormone (PTH) level (3957 ng/L). Ultrasound studies of the neck revealed a 2 cm well-defined mass inferoposterior to right thyroid lobe. CT scans of the neck showed a normal mediastinum and confirmed no associated lymphadenopathy. Having undergone medical resuscitation for 9 days, a neck exploration revealed a cystic mass, which was excised. Histological investigations revealed a 9.25 g, cystic parathyroid adenoma with no features of malignancy. His PTH and CCa2+ returned to normal postoperatively. This suspicious presentation of benign disease, including a marked elevation in PTH, highlights the challenges facing the endocrine surgeon in dealing with parathyroid disease.

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Primary Hyperparathyroidism: Role of the Preoperative Oral Calcium Loading Test in the Differential Diagnosis Between Adenoma and Hyperplasia

Cited by 8 publications

References 36 publications

Sporadic multiple parathyroid gland disease—a consensus report of the European Society of Endocrine Surgeons (ESES)

Sporadic multiple parathyroid gland disease—a consensus report of the European Society of Endocrine Surgeons (ESES)

A case report: Giant cystic parathyroid adenoma presenting with parathyroid crisis after Vitamin D replacement

A Parathyroid Adenoma: Benign Disease Presenting with Hyperparathyroid Crisis

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