Spontaneous parathyroid adenoma hemorrhage

We report a case of spontaneous parathyroid adenoma hemorrhage. A 50-year-old man with a sore throat, and swelling and ecchymosis of the entire anterior neck was found in cervical and chest computed tomography revealed to have a low-density area extending from the parapharyngeal region to below the carina, Suspecting descending necrotizing mediastinitis secondary to a peritonsillar abscess, we conducted mediastinal and cervical drainage, but found no abscess. No evidence was found, either, in bacteriological culture of sputum and pleural effusion. After the hematoma disappeared, cervical ultrasonography indicated parathyroid adenoma. Serum calcium was marginally increased, indicating that serum calcium should be determined if cervical or mediastinal hematoma develops without an obvious cause.     

Hyperfunctioning intrathyroid parathyroid adenoma: Report of two cases

We report herein two cases of intrathyroid parathyroid adenoma, which is a rare condition in patients with hyperparathyroidism. In the first patient, an excised intrathyroid nodule was diagnosed to be parathyroid adenoma postoperatively. In the second patient, preoperative localization studies suggested the possibility of an intrathyroid adenoma. When a pathological gland is not found during surgery for primary hyperparathyroidism, an ectopic parathyroid gland including an intrathyroid adenoma should thus be considered.     

Recurrence of primary hyperparathyroidism following spontaneous remission with intracapsular hemorrhage of a parathyroid adenoma

A few patients with primary hyperparathyroidism (PHPT) have a chance of spontaneous remission by either infarction of or hemorrhage into or around the parathyroid adenoma. In most cases, biochemical derangements associated with PHPT are permanently improved after spontaneous remission. Here we report a case with a recurrence of PHPT 4 months after spontaneous remission with acute intracapsular hemorrhage of parathyroid adenoma. In the literature, only two cases have been reported to have experienced a recurrence of clinical features of PHPT after infarction but not hemorrhage of parathyroid adenomas. Thus, the spontaneous remission of biological derangements in PHPT upon hemorrhage or infarction of parathyroid adenoma could be temporary. One should carefully observe such patients thereafter.     

Correlation of biochemical parameters with single parathyroid adenoma weight and volume

OBJECTIVE: To determine the relationship of the biochemical parameters serum phosphate, serum calcium, and serum parathyroid hormone levels with respect to parathyroid adenoma weight and volume in primary hyperparathyroidism. STUDY DESIGN: Retrospective review of 63 cases of primary hyperparathyroidism from 1992 to 1998. METHODS: Single parathyroid adenomas were identified from surgical pathology reports. Preoperative calcium, phosphate, and parathyroid hormone levels were collected from charts. The volume of the adenoma was calculated using a mathematical equation for the volume of an ellipsoid object. The data were analyzed using a multiple analysis of variance, and a correlation coefficient was calculated. The level of significance was set at p < or = .05. RESULTS: With respect to adenoma volume, there was a significant correlation with serum calcium and parathormone levels (p = .0001 and p = .0001, respectively). There was no significant correlation between serum phosphate and adenoma volume. With respect to adenoma weight, there was a significant correlation with serum calcium and parathormone levels (p = .0001 and p = .0001, respectively). There was no significant correlation between serum phosphate and adenoma weight. CONCLUSIONS: Preoperative serum calcium and parathormone levels may be able to predict adenoma weight and volume in primary hyperparathyroidism for a single adenoma.     

甲状旁腺腺瘤合并甲状腺结节34例临床分析

目的探讨甲状旁腺腺瘤合并甲状腺结节的诊断及外科治疗方法。方法回顾性分析我院收治的34例甲状旁腺腺瘤合并甲状腺结节的临床诊治经验。结果甲状旁腺腺瘤单侧单发多见(3l/34),单侧甲状旁腺腺瘤合并同侧甲状腺结节多见(25/31)。甲状腺结节病变性质主要为结节性甲状腺肿(27/34)。34例均行外科手术治疗。术后早期有8例患者出现短时的低钙血症,余无明显并发症。术后随访26例,全部患者甲状旁腺腺瘤均无明显复发迹象,结节性甲状腺肿患者有2例术后复查再次发现甲状腺结节,均予以动态观察,未行进一步手术切除,其余病例甲状腺结节均无复发。结论手术切除是治疗甲状旁腺腺瘤合并甲状腺结节的最有效的方法,最常用手术方式为单侧颈部探查术,术前定性及定位诊断结合术中诊断是手术成功的关键。     

Identification of pathologic parathyroid glands in patients with primary hyperparathyroidism

r = 0.861, intact PTH assay). Eight of 9 patients with multiple-gland involvement had an elevated serum PTH (>2000 pg/ml in midportion and >200 pg/ml in intact PTH assays, respectively). No patient developed persistent or recurrent hyperparathyroidism. The serum PTH level was normalized by a resection of relatively enlarged glands in our cases. It is usual to explore all glands during surgery, and in cases with a high serum PTH level, multiple-gland involvement should also be considered. (Received for publication on Feb. 10, 1997; accepted on July 8, 1997)     

Day-case minimally invasive excision of a giant mediastinal parathyroid adenoma

Inferior parathyroid adenomas in the mediastinum can be a troublesome cause for hypercalcaemia, requiring a full collar incision or, occasionally, a sternotomy. We report a case of a giant parathyroid adenoma in a 61-year-old woman on warfarin, which we excised via a minimally invasive transcervical approach after radiological localisation. The procedure was performed as a day case and, at six weeks, the patient had recovered fully with biochemical resolution of hypercalcaemia. This case demonstrates that focused transcervical excision of giant parathyroid adenomas is a viable option and should be considered prior to neck exploration or sternotomy.     

Hungry bone syndrome after parathyroidectomy caused by an ectopic parathyroid adenoma

Hungry bone syndrome (HBS), i.e., persistent hypocalcemia and hypophosphatemia as a result of extensive remineralization, is rarely encountered in children after parathyroid surgery. Herein, we report a 12-year-old girl who was diagnosed to have an ectopic parathyroid adenoma, and HBS was observed in the postsurgical follow-up. The diagnosis and the risk factors are discussed in the light of the literature.     

Management of mediastinal parathyroid adenoma via minimally invasive thoracoscopic surgery: Case report

IntroductionThe most common cause of chronic hypercalcemia is primary hyperparathyroidism (PHPT). However, owing to the diverse presentation of hypercalcemia, the diagnosis often goes unnoticed culminating as a continuum of recurrence of symptoms. Nephrolithiasis, decreased bone mineral density and peptic ulcer disease are the main clinical sequelae. Among the causes of PHPT 80% are caused by parathyroid adenomas (PA). However, only rarely, these adenomas are found ectopically.Presentation of caseWe present the case of a 66-year-old female with a history of recurrent renal stones and peptic ulcer disease. She was found to have elevated serum calcium and PTH levels. However, subsequent high resolution CT scan of chest and neck failed to demonstrate any abnormality. Therefore, an anterior planar Technetium-99m-sestamibi (MIBI) scintigraphy scan using a single-tracer was done and it identified ectopic anterior mediastinal parathyroid adenoma. The patient was successfully managed with video-assisted thoracoscopic surgery and excision of the mass with follow up calcium level monitoring.DisscussionAn elevated calcium level should prompt a thorough workup, as sometimes it's the only clue to the unrelated and diversified systemic manifestations of hypercalcemia. Hyperparathyroidism due to ectopic adenoma is quite rare and possess a diagnostic and management challenge.ConclusionSymptomatic hypercalcemia and high level of PTH without local PA should alert physicians to search for ectopic locations through imaging. VATS is a safe and effective minimally invasive procedure for the resection of ectopic mediastinal PA and it should be considered as the first line approach for resection of these ectopic tumors.     

彩色多普勒超声诊断巨大甲状旁腺腺瘤1例

患者女,49岁,4个月前偶然发现右颈部包块,持续增大,伴隐痛,无恶心、呕吐,无寒战发热,无声音嘶哑,无饮水呛咳等不适。查体：右颈部可扪及3.5cm×5.0cm包块,质韧,无触痛,以＂右侧甲状腺占位＂收入院。入院后放射性核素显像：甲状旁腺显像,未见甲状旁腺腺瘤征象（图1）。颈部CT：     

Mediastinal parathyroid adenoma detected by99mTc-methoxyisobutylisonitrile: Report of a case

We report herein the case of a 30-year-old man in whom ectopic mediastinal parathyroid adenoma was detected by^19mTc-methoxyisobutylisonitrile scintigraphy (^99mTc-MIBI). The patient presented with a history of recurrent renal stones and was diagnosed as having primary hyperparathyroidism due to elevated serum levels of calcium and intact parathyroid hormone (i-PTH) levels. On admission, his serum calcium value was 12.1 mg/dl and the i-PTH level was 137 pg/ml. Ultrasonography, computed tomography (CT), and 201TlCl-^99mTcO^– ₄ subtraction scintigraphy (TI-Tc) were performed but none of these imaging techniques was able to detect an enlarged parathyroid gland. Selective venous sampling revealed that the serum i-PTH level was highest at 422pg/ml in the left brachiocephalic vein. Exploration of the neck also proved unsuccessful. Finally, we performed^99mTc-MIBI which revealed and delineated an enlarged parathyroid gland in the upper mediastinum. Tumor extirpation was subsequently performed through a left thoracotomy. Pathologically, the tumor was confirmed to be a parathyroid adenoma and the serum calcium and i-PTH levels returned to within the normal ranges postoperatively.     

Surgical management of a giant parathyroid adenoma through minimal invasive parathyroidectomy. A case report

IntroductionPrimary hyperparathyroidism is a common endocrine disorder mostly associated to parathyroid adenomas. Although those tend to be small in size, rare cases of giant parathyroid adenomas may be present.Case presentationA 42 year old female was admitted in our department due to weakness and vague abdominal pain for the past 8 months. Preoperative laboratory exams indicated primary hyperparathyroidism as a cause to her symptomatology, with elevated values of parathormone and normal values of serum calcium. Ultrasound scan and 99 m Tc-MIBI of her cervical region uncovered a giant 3 × 2 cm parathyroid adenoma, located in the lower left thyroid lobe. Despite its size, the gland was successfully removed through implementation of minimal invasive parathyroidectomy. She was uneventfully discharged on the 1st postoperative day.DiscussionAlthough a common reason for developing hyperparathyroidism, parathyroid adenomas may rarely present with exaggerated dimensions and weight. Physical examination is usually unremarkable, while patients may present with symptomatology associated with elevated calcium levels. Treatment of this medical condition consists of surgical removal of the pathologic parathyroid gland either by bilateral neck exploration or through minimal invasive parathyroidectomy. Preoperative localization plays an important role in the second case, since the method focuses on resection of a pre-op marked hyperactive parathyroid gland, through a small incision.ConclusionClinicians must be alerted of hyperparathyroidism in patients presenting with calcium associated symptomatology. Diagnosis is straightforward through laboratory exams, while surgery offers the only permanent treatment option.     

Preoperative evaluation of microencapsulated human parathyroid tissue aids selection of the optimal bioartificial graft for human parathyroid allotransplantation

Allotransplantation of microencapsulated parathyroid tissue is a promising approach to the treatment of permanent hypoparathyroidism. Preoperative assessment of the quality of microencapsulated parathyroid tissue could facilitate selection of the optimal bioartifical graft for human parathyroid allotransplantation. Parathyroid tissue from patients with secondary hyperparathyroidism (n = 15) was processed mechanically or enzymatically (collagenase type II). Tissue particles and single cells/cell clusters were routinely microencapsulated with amitogenic Ba(2+) alginate. Parathyroid secretion dynamics in response to stimulation of nonencapsulated and microencapsulated parathyroid tissue with Ca(2+) were evaluated in a perifusion system. The stability of the different types of microcapsule was assessed using an osmotic pressure test. Mechanical cutting of parathyroid tissue led to peripheral necrosis of tissue particles and impaired their vitality. Collagenase digestion, in contrast, resulted in single cells and cell clusters without peripheral necrosis. The quality of microencapsulation of single cells/cell clusters was significantly better than that of tissue particles (deformed and imperfect capsules). Microencapsulation itself did not decrease cell vitality. Nonencapsulated and microencapsulated tissue particles and single cells/cell clusters from different donors maintained their own levels of response to stimulation with low Ca(2+). Microcapsules containing tissue particles showed poor stability compared with those containing single cells/cell clusters. Preoperative evaluation of microencapsulated parathyroid tissue can disclose differences in vitality and function and thus facilitate selection of the optimal bioartifical graft for human parathyroid allotransplantation.