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PubMed1999

[Clear cell adenoma of the parathyroid gland: a rare and misleading lesion].

Parathyroid adenomas are common lesions and are considered to be the cause of most of the primary hyperparathyroidism cases. We report the case of a 73 year-old man who presented with a primary hyperparathyroidism. Clinical and histological explorations revealed the presence of an isolated parathyroid tumor containing exclusively clear cells and devoid of malignancy. This is the second reported case of clear cell parathyroid adenoma. Thus, in spite of its low occurrence, this diagnosis must be considered after rejection of the most frequent parathyroid clear cell hyperplasia and parathyroid carcinoma, or depending of the location, clear cell thyroid tumor and clear cell renal carcinoma metastasis.

Adenoma↗
PubMed1976

[Toxic thyroid adenoma and malignant hypercalcemia of parathyroid origin].

Malignant hypercalcemia due to the association of hyperthyroidism and hyperparathyroidism is rare. We report a case with a fatal course in spite of surgical treatment of both lesions. Death occurred seven days after the operation due to ventricular tachycardia, in spite of return to normal of the calcemia, the serum phosphorus, the serum electrolytes and relief of the thyro-toxicosis. There is a great deal of histopathological evidence for the association of a toxic parathyroid carcinoma and a thyroid adenoma.

Female↗
PubMed2006

Parathyroid adenocarcinoma in a nephropathic Persian cat.

This report describes an uncommon clinical case of cystic parathyroid adenocarcinoma. A 17-year-old male Persian cat was presented for evaluation of a ventral cervical mass. The cat was inappetent and showed weight loss, polydipsia and vomiting. Serum biochemistry and urinalysis revealed moderate hypercalcaemia, a mild increase of creatinine, isosthenuria and proteinuria. Sodium dodecyl sulphate-agarose gel electrophoresis showed a mixed tubular proteinuric pattern, in accordance with histological examination that revealed interstitial nephritis and glomerulonephritis. Diagnosis of parathyroid carcinoma was based on histopathological findings.

Adenocarcinoma↗
PubMed2006

Parathyroid imaging: how good is it and how should it be done?

Hypersecretion of parathormone in primary hyperparathyroidism is common, occurring in approximately 1 in 500 women and 1 in 2,000 men per year in their fifth to seventh decades of life. This has been suggested from the literature to be primarily the result of a parathyroid adenoma (80-85% of cases), hyperplasia involving more than 1 gland, usually with all 4 glands being involved (10-15% of cases), or the result, albeit rarely, of parathyroid carcinoma (0.5-1% of cases). Surgical removal of the hypersecreting gland is the primary treatment; this procedure is best performed by a skilled surgeon who would normally find the abnormality in 95% of cases. Imaging, however, should be used to identify the site of abnormality, potentially reducing inpatient stay and improving the patient experience. Functional imaging of parathyroid tissue using thallium was introduced in the 1980s but has largely been superceded by the use of (99m)Tc-labeled isonitriles. The optimum techniques have used (99m)Tc-sestamibi with subtraction imaging or washout imaging. A recent systematic review reported the percentage sensitivity (95% confidence intervals) for sestamibi in the identification of solitary adenomas as 88.44 (87.48-89.40), multigland hyperplasia 44.46 (41.13-47.8), double adenomas 29.95 (-2.19 to 62.09), and carcinoma 33 (33). This review does not separate the washout and subtraction techniques. The subtraction technique using (99m)Tc-sestamibi and (123)I is the optimal technique enabling the site to be related to the thyroid tissue when the parathyroid gland is in the neck in a normal position. If there is an equivocal scan then confirmation with high resolution ultrasound should be used. With ectopic glands, the combined use of single-photon emission computed tomography may then provide anatomical information to enable localization of the functional abnormality. In patients who have had surgical exploration by an experienced parathyroid surgeon in a unit with an experienced nuclear medicine team and negative sestamibi imaging, it is reasonable to image the patient with (11)C methionine. It is debatable whether patients with a high likelihood of secondary hyperparathyroidism should be imaged. The only possible justification for this is to exclude an ectopic site. There is no substitute for an experienced surgeon and an experienced imaging unit to provide a parathyroid service.

Adenoma↗
PubMed1986

[Immunohistochemistry of thyroglobulin in the diagnosis of clear cell carcinomas of the cervical region].

6 thyroid gland and 3 cervical lymph node clear-cells carcinomas are investigated by means of indirect immunofluorescence detection of thyroglobulin. Immunofluorescence was positive only in 1 case, which was a primitive thyroid carcinoma. In 7 other cases, its negativity pointed at the metastatic nature of the lesion, from a clear cell carcinoma of kidney (in 4 cases, nephrectomy was very remote, and in 3 cases, the renal lesion was discovered after our examination of the thyroid tumour). One observation showed negative staining reaction, and was a propagation of a parathyroid carcinoma to the thyroid gland. It is concluded that thyroglobulin can be used as an immunohistochemical marker to establish whether a clear cell cervical tumour originates from thyroid gland, or is a metastatic neoplasm.

Adenocarcinoma↗
PubMed1995

[99mTc-MIBI scintigraphy for the detection of parathyroid lesions in patients with hyperparathyroidism].

The usefulness of 99mTc-MIBI scintigraphy for the detection of parathyroid lesions was evaluated in 17 patients with hyperparathyroidism. Delayed image was used to evaluate the lesions. Detectability of MIBI for parathyroid lesions was 86% (18/21). The smallest lesion detected was parathyroid hyperplasia weighted 270 mg. Ectopic parathyroid adenoma and bone metastases of parathyroid carcinoma were clearly demonstrated. Detectability of MIBI scintigraphy for the lesions including ectopic and metastatic lesions was the highest among those of ultrasonography, CT and MRI methods. MIBI scintigraphy was thought to be useful for the detection of parathyroid lesions, especially for ectopic and metastatic lesions.

Bone Neoplasms↗
PubMed1983

Anaesthesia and hyperparathyroidism. A case report.

A 25-year-old White woman was admitted for exploratory thoracotomy for the removal of metastatic lesions from a hormonally active parathyroid carcinoma. The medical, intra-operative and anaesthetic implications are discussed.

Adult↗
PubMed1968

Tertiary hyperparathyroidism.

In our first 200 cases of primary hyperparathyroidism confirmed by operation 12 were also shown to have a long history either of a malabsorption syndrome or of chronic renal-glomerular failure. We consider that they first went through a phase of secondary hyperparathyroidism, during which one or more of the glands became autonomous adenamata. This then produced the biochemical changes of "primary" hyperparathyroidism, necessitating excision of the adenoma. This condition is best described as "tertiary" hyperparathyroidism. The transition from secondary to tertiary hyperparathyroidism occurred in four of the 12 patients while under our observation. We think the same process can be traced retrospectively in the other eight cases. The concept of tertiary hyperparathyroidism may help to explain the high incidence of other diseases in association with primary hyperparathyroidism.The behaviour of the parathyroid glands provides a valuable model for the investigation of tumour formation in man. All states occurred in our patients with primary hyperparathyroidism, from normal through hyperplasia to adenoma formation and finally to parathyroid carcinoma.

Adenoma↗
PubMed1994

Long-term follow-up after total parathyroidectomy without parathyroid reimplantation in chronic renal failure.

Forty-three patients with secondary or autonomous hyperparathyroidism complicating chronic renal failure (CRF) underwent total parathyroidectomy (PTX) (follow-up 2-18 years, mean 8.7 years). Five were on conservative treatment for CRF, 35 on regular dialysis, and only three had a functioning allograft. At PTX, the most frequent findings were uncontrollable hypercalcaemia, musculo-skeletal pain, radiographic changes in the phalanges, and raised plasma parathyroid hormone (PTH) concentration. Pre-operatively, all patients were loaded with dihydrotachysterol or 1-alpha-OH cholecalciferol. Postoperatively, they were maintained on tapering doses of the same drugs and, briefly, oral calcium supplements. Five glands were identified and removed in two patients, four in 35 patients, three in three patients and only two in one patient. All had changes of hyperplasia and adenoma formation, except for one with a parathyroid carcinoma. Prompt symptomatic and radiographic improvement occurred, with normalization of plasma calcium and alkaline phosphatase. Postoperative PTH levels were available in 33 patients (23 by intact PTH assay): they were persistently high in 10/33 (2/23 intact); normal in seven (6 intact); low in 11 (3 intact), and undetectable in four (3 intact). Thus, PTX was incomplete in the majority of patients. Following transplantation, 3/20 (3/18 intact) patients still had detectable PTH. Only one patient developed symptomatic recurrent parathyroid disease requiring re-operation, and complications were few. Small dosages of vitamin D continue to be required, but not calcium supplementation, and no clinical effects of possible adynamic bone have been noted. At later renal transplantation in 27 patients, an easily treatable, uncomplicated hypocalcaemia was noted in 33%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoma↗
PubMed2002

Are preoperative serum calcium, parathyroid hormone, and adenoma weight predictive of postoperative hypocalcemia?

The objective of this study is to determine whether preoperative serum calcium, parathyroid hormone, or adenoma weight is predictive of postoperative hypocalcemia after removal of a parathyroid adenoma. A retrospective chart review was performed for consecutive parathyroidectomy patients over a 6-year period at a community-based teaching institution. Patients with renal failure (serum creatinine >1.7), hyperplastic disease, and parathyroid carcinoma were excluded. The outcome measures were postoperative serum calcium and the presence of signs or symptoms such as paresthesias, anxiety, or Chvostek's sign. One hundred forty-one patients underwent parathyroidectomy during the study period. Fifty-four patients were excluded as a result of hyperplastic disease, renal failure, carcinoma, or unavailable records. Of the remaining 87 patients 25 (28.7%) developed hypocalcemia (serum calcium < 8.0), and ten patients (11.5%), developed symptoms. The mean preoperative calcium levels for the normocalcemic and hypocalcemic groups were 10.9 and 10.6, respectively (P < 0.217). The mean preoperative parathyroid hormone levels (normal 10-54) were 214 and 139, respectively (P < 0.305), and the mean adenoma weights were 1.059 and 1.337 g respectively (P < 0.343). This study demonstrates no statistically significant difference in the mean preoperative serum calcium levels, parathyroid hormone levels, or adenoma weight between normocalcemic and hypocalcemic patients postoperatively.

Adenoma↗
PubMed1981

ABO(H) cell surface antigens in parathyroid adenoma and hyperplasia.

Forty-three cases of primary hyperparathyroidism were studied with the specific red cell adherence test (SRCA) to determine the presence or absence of ABO(H) cell surface antigens on abnormal parathyroid tissue. Of the 27 patients with the clinicopathologic diagnosis (CPD) of adenoma, 24 (89%) had lost the ABO(H) cell surface antigen of the abnormal gland. Among the 15 patients with the CPD of hyperplasia, the parathyroid tissue from three (20%) had lost its red cell antigen. In one patient, a metastasis from a parathyroid carcinoma had lost the ABO surface antigen. Several patients in whom conflicting SRCA and CPD were obtained had factors that raised doubts as to the validity of their CPD. The SRCA is a simple test that may aid in the difficult differentiation between parathyroid adenoma and hyperplasia.

ABO Blood-Group System↗
PubMed2000

Brown tumour of hyperparathyroidism in the mandible associated with atypical parathyroid adenoma.

The brown tumour of hyperparathyroidism is a localized bone tumour and an uncommon manifestation of hyperparathyroidism. A 27-year-old woman presented with a mandibular 8 x 10 cm solid mass diagnosed as central giant cell granuloma. Chemical blood analysis revealed increased serum calcium levels of 12.46 mg/dL and the parathyroid hormone level was 124 pg/dL. The patient underwent surgery with removal of a parathyroid mass. Histologically, this parathyroid tissue was seen to be limited by a fibrous capsule with morphological features consistent with atypical parathyroid adenoma. The mandibular tumour has receded and the patient declined further procedures. This is the first case reported of brown tumour as the primary manifestation of an atypical parathyroid adenoma, a lesion that shares some features with parathyroid carcinoma without the unequivocal properties of malignancy.

Adenoma↗
PubMed2004

Calcimimetics and hyperparathyroidism.

The calcium-sensing receptor (CaSR) is a key regulator of parathyroid hormone (PTH) secretion and parathyroid proliferation. This review discusses the role of the CaSR in hyperparathyroidism (HPT), and the exploitation of the CaSR as a therapeutic target for the treatment of HPT. Calcimimetics act as CaSR agonists or allosteric activators and thereby potentiate the effects of extracellular Ca2+ on parathyroid cell function. Results from clinical trials using calcimimetics to treat primary and secondary HPT, as well as primary HPT from parathyroid carcinoma, suggest that calcimimetic compounds could provide an effective alternative or additional therapeutic approach for various forms of HPT.

Aniline Compounds↗
PubMed2005

Normalization of reversed bio-intact-PTH(1-84)/intact-PTH ratio after parathyroidectomy in a patient with severe secondary hyperparathyroidism.

The conventional intact-PTH assay detects both (1-84)-PTH and C-terminal fragments. The newer PTH assays, bio-intact-PTH assay and whole-PTH assay, use an antibody that binds only if the first amino acid is present, making it specific for the complete molecule, (1-84)-PTH. Thus, the intact-PTH concentrations are theoretically higher than bio-intact-PTH concentrations, and the ratio of bio-intact-PTH/intact-PTH is usually less than 1. These findings are observed in normal subjects and patients with primary and secondary hyperparathyroidism. Here we present a hemodialysis patient with severe secondary hyperparathyroidism who was found to have abnormally higher plasma bio-intact-PTH concentrations than intact-PTH concentrations, and the abnormally high biointact-PTH/intact-PTH ratio improved after parathyroidectomy (PTx). The patient was a 67-year-old man on maintenance hemodialysis since 1995. Since 2003, he was found to have high plasma intact-PTH concentrations and two swollen parathyroid glands in the neck. PTx with forearm autograft was performed in October 2003. Before PTx, an abnormally high ratio of bio-intact-PTH/intact-PTH was detected (840 pg/ml/770 pg/ml, > 1), while the same ratio was improved to normal range (100 pg/ml/200 pg/ml, < 1). Recently, a few patients with parathyroid carcinoma have been found to have higher (1-84)-PTH concentrations than intact-PTH concentrations with abnormally high (1-84)-PTH/intact-PTH ratio. Moreover, a new molecular form of PTH distinct from (1-84)-PTH was detected in these patients. We speculate that the resected parathyroid gland in our patient might have produced a new molecular form of PTH that was less well detected by the conventional intact-PTH assay.

Aged↗
PubMed2001

Clinical role of 99mTcO4/MIBI scan, ultrasound and intra-operative gamma probe in the performance of unilateral and minimally invasive surgery in primary hyperparathyroidism.

The main purposes of this study were: (a) to investigate the efficacy of an imaging protocol based on the combination of 99mTcO4/MIBI scintigraphy and neck ultrasound (US) in selecting patients with primary hyperparathyroidism (HPT) for unilateral neck exploration, and (b) to help define the role of the intraoperative MIBI gamma probe (IMGP) technique in the performance of minimally invasive radio-guided surgery (MIRS). One hundred and forty-three consecutive patients with primary HPT were enrolled in the study. We used a modified 99mTcO4/MIBI scintigraphic procedure which included the oral administration of potassium perchlorate to cause rapid 99mTcO4 washout from the thyroid tissue, thereby permitting the acquisition of high-quality early MIBI images. A single-photon emission tomography (SPET) acquisition was also obtained in 21 patients, of whom seven had an enlarged parathyroid gland (EPG) in the mediastinum at planar scintigraphy and 14 had discordant scan/US findings for the presence of a cervical EPG. Neck US was performed in the same session as scintigraphy using a small-parts, high-resolution 10-MHz transducer. All patients were then operated on by the same surgical team. Quick PTH assay (QPTH) was used to measure PTH intraoperatively to confirm successful parathyroidectomy. In patients with scan/US evidence of a solitary EPG and with a normal thyroid gland, limited, unilateral neck surgery or, more recently, MIRS was planned (n=91). In patients with scan/US evidence of multiglandular disease (MGD) (n=21) or concomitant nodular goitre (n=24) or in patients with a negative scan/US evaluation (n=7), extensive bilateral neck exploration was planned (n=52). In 87 of the 91 patients (95.6%) in whom preoperative imaging indicated the presence of a solitary EPG and a normal thyroid gland, a single parathyroid adenoma was found at surgery, and these patients were treated by unilateral neck exploration or MIRS. In the remaining four patients of this group, conversion to bilateral neck exploration was required because parathyroid carcinoma (n=3) or MGD (n=1) was diagnosed at operation. In some cases SPET was helpful in better localising the EPG. In particular, in 5 of the 21 patients evaluated, SPET localised an EPG deep in the neck or mediastinum and at surgery a parathyroid adenoma was found in the paratracheal or para-oesophageal space. In 43 of the 46 patients (93.5%) who were candidates for MIRS, the IMGP technique allowed parathyroidectomy to be performed through a small, 2- to 2.5-cm skin incision with a short duration of intervention (mean 34 min). We conclude that: (a) The integrated scan/US imaging protocol that we used appears to be accurate in selecting patients with primary HPT for unilateral neck exploration. (b) In our series the most prevalent cause of bilateral neck exploration was the co-existence of a nodular goitre; thus accurate preoperative evaluation of the thyroid gland by dual-tracer scintigraphy and US imaging is strongly recommended in all patients with HPT. (c) SPET can provide the surgeon with useful information when an EPG is located deep in the neck or mediastinum. (d) IMGP appears to be a useful intraoperative device in HPT patients with solitary parathyroid adenomas and a normal thyroid gland, since it permits minimally invasive and time-saving surgery.

Adenoma↗
PubMedDate not supplied

Thyroid and parathyroid surgery without drains.

The question of routine wound drainage after thyroid and parathyroid surgery remains controversial among experienced surgeons. Review of the literature failed to reveal any study that established the benefit of drainage after thyroidectomy and parathyroidectomy. A retrospective review of 139 thyroid or parathyroid procedures performed without drainage was conducted. One hundred ten thyroid operations were performed, including unilateral lobectomy with isthmusectomy [82 (74.5%)], total or bilateral subtotal thyroidectomy [26 (23.6%)], and isthmusectomy [2 (1.8%)]. Histologic examination yielded a benign diagnosis in 94 specimens (85.4%); 16 specimens (14.5%) contained thyroid carcinoma. Parathyroid explorations were performed in 29 patients (20.8%) all of whom had adenomas. Postoperatively, there were no instances of wound hematomas, infections, or rebleeding necessitating reoperation. Minor complications included asymptomatic wound seromas (4-30 mL) in five (3.6%) patients, which were aspirated 2 weeks after discharge without further recurrence. This minimal complication rate of 3.6% with undrained neck incisions suggests that routine prophylactic drainage of thyroid and parathyroid wounds is unnecessary.

Adolescent↗
PubMed1995

Unusual cases of hyperparathyroidism.

The history, physical and radiologic findings, treatment and pathology in five unusual cases of hyperparathyroidism is presented. The hyperparathyroidism was caused by a large (113 grams) mediastinal adenoma in the first patient, who is alive 25 years after surgery. A parathyroid carcinoma with compression of the esophagus was documented in the second patient. This patient is alive and normocalcemic 23 years after surgical treatment. A third patient with hyperplasia returned with hypercalcemia 20 years postsurgery requiring reoperation. A fourth patient with advanced bone findings was found to have a parathyroid adenoma. The fifth case is a patient with tertiary hyperparathyroidism secondary to hypophosphatemic rickets.

Adenoma↗