Giant parathyroid adenoma (GPA) is defined as adenoma larger than 3.5 g. Twenty-one cases of parathyroid mass >3.5 g in patients with primary hyperparathyroidism who underwent parathyroidectomy in Hospital Putrajaya, Malaysia were identified. Most cases presented with nephrolithiasis. Two cases are reported as parathyroid cancer. GPA has significantly higher serum calcium and iPTH levels and can be asymptomatic. Parathyroid carcinoma patients are frequently symptomatic, with large tumors. Differentiating GPA from parathyroid cancer is important as it determines the subsequent surgical intervention.
Hyperparathyroidism ; Parathyroid Neoplasms ; Parathyroidectomy ; Calcium ; Adenoma

One of the common complications of parathyroid surgery is the development of postoperative hypocalcemia. Hypocalcemia may result from the redistribution of serum calcium as well as the insufficient supply of parathyroid hormone from the parathyroid tissues remaining after the parathyroidectomy. Hungry bone syndrome is postoperative hypocalcemia that takes place due to rapid redistribution of serum calcium to the bone and requires a long-term medical management. We have experienced a 34-year-old man who presented brown tumor in the left humerus and developed hungry bone syndrome after resection of a parathyroid gland adenoma. We report this case with a review of the literature.
Adenoma ; Adult ; Calcium ; Humans ; Humerus ; Hypocalcemia ; Parathyroid Glands ; Parathyroid Hormone ; Parathyroid Neoplasms* ; Parathyroidectomy

Cystic parathyroid adenoma is one of rare causes of hyperparathyroidism, and tends to cause increased serum level of parathyroid hormone, alkaline phosphate and serum calcium level similar to when compared to those of solid adenoma.
Adenoma ; Calcium ; Carcinoma ; Hyperparathyroidism ; Parathyroid Hormone ; Parathyroid Neoplasms ; Thyroid Gland ; Thyroid Neoplasms

A rare case of functioning oncocytic parathyroid adenoma associated with primary hyperparathyroidism was found in a 45-year-old woman. The preoperative serum calcium level was 13.1 mg/dL, the phosphate level was 2.44 mg/dL and the parathyroid hormone level was 153 pg/mL. Neck CT revealed a 2.5x1x1 cm, well enhanced mass behind the left thyroid gland, which was compatible with parathyroid adenoma. The removed parathyroid gland showed a well circumscribed, ovoid, brown colored, soft, solid mass. Histologically, this mass was composed of broad sheets of uniform cells having round dense nuclei and abundant eosinophilic granular cytoplasms. The adjacent rim of the normal parathyroid tissue was identified in the periphery of the mass. After operation, all hormone levels were normalized.
Adenoma ; Calcium ; Cytoplasm ; Eosinophils ; Female ; Humans ; Hyperparathyroidism, Primary* ; Middle Aged ; Neck ; Parathyroid Glands ; Parathyroid Hormone ; Parathyroid Neoplasms* ; Thyroid Gland

OBJECTIVETo investigate the causes of misdiagnosis and the surgical treatment of primary hyperparathyroidism (PHPT).

METHODSThe clinical data of 26 patients with PHPT from July 2008 to January 2013 in The Affiliated Hospital of Chengde Medical College and The Fourth Hospital of Hebei Medical University were retrospectively analyzed, including preoperative diagnosis and operative method. The level of serum calciumion and serum parathyroid hormone (PTH), Ultrasonography, CT, (99)mTc-methoxy isobutylis onitrile ((99)mTc-MIBI) were used in the diagnosis before operation. All patients accepted surgical treatment after the level of serum calciumion decreased to normal.

RESULTSThe level of PTH was examined 10 min after resection, which declined more than 50%. After pathological examination, 23 cases were diagnosed as parathyroid adenoma, 2 cases were parathyroid hyperplasia, and 1 case was parathyroid carcinoma. The level of serum calciumion and serum parathyroid hormone were returned to the normal level after operation. All patients recovered with no postoperative complication.Followed up lasted from 6 months to 5 years, no case recurred.Sixteen cases with symptoms experienced significant improvement in signs, including 10 cases with clinical symptoms completely disappeared.

CONCLUSIONSThe test of serum calciumion and serum PTH, Ultrasonography, CT, (99)mTc-MIBI are helpful to reduce the misdiagnose rate of primary hyperparathyroidism before operation. The examination of serum parathyroid hormone in operation is helpful to reduce the operation range and time.

: The parathyroid glands play a crucial role in calcium regulation through parathyroid hormone (PTH) production. Indicators for those with hyperparathyroidism would be elevated serum calcium and PTH levels with further evaluation followed by imaging with neck ultrasonography and parathyroid scintigraphy. Limitations in the initial imaging modalities include operator-dependent sensitivity in neck ultrasonography, and poor spatial resolution, and poor sensitivity for smaller-sized adenomas in parathyroid scintigraphy. : This case report describes a 24-year-old female with elevated parathyroid hormone, and borderline elevated calcium levels with an initial diagnosis of primary hyperparathyroidism secondary to a suspected parathyroid adenoma. The dual tracer dual-phase scintigraphy accompanied by SPECT/CT and subtraction method was negative for a parathyroid adenoma, however, ultrasonography of the neck showed a suspicious nodular structure. Due to the high clinical suspicion, a subsequent 18F-Choline PET/CT was done and identified an 18F-Choline-avid lesion, highly suggestive of a parathyroid adenoma. This prompted parathyroidectomy in which histopathology as well as intraoperative reduction in parathyroid hormone levels, confirmed the presence of a parathyroid adenoma. This is the first recorded 18F-Choline PET/CT usage for a parathyroid adenoma in the country and highlights the potential of its usage as a sensitive and specific imaging modality in cases where conventional imaging is inconclusive.
Human ; Female ; Young Adult: 19-24 yrs old ; parathyroid adenoma ; parathyroid neoplasms ; hyperparathyroidism

Cystic parathyroid adenoma is one of the rare causes of hyperparathyroidism, and is usually located in neck and mediastinum. This type of adenoma tends to cause increased serum level of parathyroid hormone and alkaline phosphatase, similar serum calcium level when compared to those of solid adenoma. Thanks to current radioimmunoassay and easy accessibility to serum autoanalyzer, serum calcium level and parathyroid hormone level are more easily measured, which in turn lead to more easier diagnosis of hyperparathyroidism. Also improvement in imaging and nuclear diagnostic method of parathyroid lesion are suggested to enable easy diagnosis of cystic parathyroid adenoma. A 35-year-old male presented with easy fatigability for 12 months. The serum calcium, phosphate, alkaline phosphotase were 11.5mg/dL, 1.4mg/dL, 194IU/L respectively and his parathyroid hormone level in serum was 126.42pg/mL. Neck CT showed enlargement of right lobe of thyroid gland with well defined inhomogenously enhanced density inside the right thyroid gland. The patient was diagnosed of hyperparathyroidim due to parathyroid adenoma and was surgically removed. The surgical biopsy showed cystic parathyroid adenoma. After operation his general condition was improved and serum calcium, phosphate, parathyroid hormone level were normalizd. We report a case of hyperparathyroidism caused by cystic parathyroid adenoma with brief review of literature.
Adenoma ; Adult ; Alkaline Phosphatase ; Biopsy ; Calcium ; Diagnosis ; Humans ; Hyperparathyroidism* ; Male ; Mediastinum ; Neck ; Parathyroid Hormone ; Parathyroid Neoplasms* ; Radioimmunoassay ; Thyroid Gland

Parathyromatosis, in which several nodules of hyperfunctioning parathyroid tissue form in the neck and mediastinum, is a rare cause of recurrent hyperparathyroidism. However, there are some theories regarding the origin of parathyromatosis, and seeding after rupture of the parathyroid gland capsule during surgical removal of a parathyroid lesions is the most regarded one. Herein, we report a 41-year-old man who presented with multiple parathyroid nodules in and around the left thyroid lobe 5 years after parathyroid surgery for secondary hyperparathyroidism that was finally diagnosed as parathyromatosis. We discuss the differential diagnosis of parathyromatosis from other parathyroid tumors, particularly from parathyroid carcinoma, which is important in the management of a suspected lesion.
Adenoma ; Adult ; Diagnosis, Differential ; Humans ; Hyperparathyroidism ; Hyperparathyroidism, Secondary ; Mediastinum ; Neck ; Parathyroid Glands ; Parathyroid Neoplasms ; Rupture ; Seeds ; Thyroid Gland

PURPOSE: This study was performed to evaluate the diagnostic usefulness of double-phase Tc-99m MIBI parathyroidism scintigraphy with single photon emission computed tomography (SPECT) in patients with hyperparathyroidism. We also evaluated the relationship between Tc-99m MIBI uptake and oxyphil cell contents in parathyroid glands. MATERIALS AND METHODS: The subjects were 28 parathyroid glands of 10 patients who underwent Tc-99m MIBI parathyroid scintigraphy and parathyroidectomy for clinically suspected hyperparathyroidism. Early and delayed pinhole images were obtained at 15 minutes and 2 hours after injection of Tc-99m MIBI, and SPECT images were followed. The weight and oxyphil cell contents of parathyroid of tissue were obtained from pathologic specimen, and the scintigraphic findings were compared with histopathology. RESULTS: In surgical histopathology, 6 parathyroid adenomas and 9 parathyroid hyperplasias were confirmed. The sensitivity, specificity, and positive predictive value of early and delayed images were 46.7% (7/15), 76.9% (10/13), 70% (7/10) and 667% (10/15), 92.3% (12/13), 90.9% (10/11), respectively. SPECT image detected an additional small hyperplasia. The sensitivity, specificity, and positive predictive value of combined interpretation of early and delayed images with SPECT were 733% f11/15), 100% (13/13), 100% (11/11). The sensitivity was 100% (6/6) for aenoma, whereas that was 555% (5/9) for hyperplasia. Both adenomas and hyperplasias showed significantly increased oxyphil cell contents compared with normal parathyroid glands (p<0.0001), but the oxyphil cell content and weight were not significantly different between adenomas and hyperplasias. CONCLUSION: Double-phase Tc-99m MIBI parathyroid scintigraphy with SPECT is useful for lesion localization m patients with hyperparathyroidism. Although both adenoma and hyperplasia have increased oxyphil cell content, the sensitivity is high in adenoma, but low in hyperplasia.
Adenoma ; Humans ; Hyperparathyroidism* ; Hyperplasia ; Parathyroid Glands ; Parathyroid Neoplasms ; Parathyroidectomy ; Radionuclide Imaging* ; Sensitivity and Specificity ; Tomography, Emission-Computed, Single-Photon

BACKGROUND: The objective of this study is to demonstrate the relationship between the volume of a parathyroid adenoma and the preoperative biochemical parameters in patients undergoing surgery for primary hyperparathyroidism. METHODS: The medical records of 68 patients who underwent a parathyroidectomy for a single parathyroid adenoma were retrospectively reviewed. The volume of the adenoma was estimated using its measured size and a mathematical formula. The correlation between the volume of the parathyroid adenoma and the preoperative laboratory data was assessed. RESULTS: There were no correlations between the estimated volume of the adenoma and the serum calcium, alkaline phosphatase and parathyroid hormone levels. However, the volume of the adenoma was associated with the preoperative level of serum phosphorus. After excluding 5 adenomas with cystic degeneration, a positive correlation was noted between the adenoma volume and the preoperative levels of alkaline phosphatase and parathyroid hormone. CONCLUSION: The preoperative serum levels of calcium, alkaline phosphatase and parathyroid hormone are of limited use to predict the volume of the parathyroid adenoma in patients with a single parathyroid adenoma. We suggest that the absence of a correlation between the volume of the adenoma and the biochemical parameters can be attributed to the cystic degeneration of the adenomas.
Adenoma ; Alkaline Phosphatase ; Calcium ; Humans ; Hyperparathyroidism ; Hyperparathyroidism, Primary ; Medical Records ; Parathyroid Hormone ; Parathyroid Neoplasms ; Parathyroidectomy ; Phosphorus ; Retrospective Studies