Clinical analyses of 75 parathyroidectomy (PTE) patients and 69 adrenalectomy (AE) patients including saliva-type amylase-secreting secondary parathyroid hyperplasia (SPTH) and insulinoma with adrenal adenoma (AA) showing primary aldosteronism

Abstract

Seventy-five parathyroidectomy (PTE) and 69 adrenalectomy (AE) patients were analyzed. The 75 PTE included 56 of secondary parathyroid hyperplasia (SPTH) with chronic renal failure (CRF) and 19 of primary parathyroid hyperplasia (PPTH) without CRF. The 69 AE included 23 with Cushing’s syndrome, 30 with primary aldosteronism, four with cortical carcinoma (three virilizing and one feminizing carcinomas), seven with pheochromocytoma (two multiple endocrine neoplasia 2A), two with paraganglioma, one with schwannoma, one with non-functional adenoma, and one with hepatic cancer metastasis. The 56 SPTH showed higher levels of intact (I)-parathyroid hormone (PT) of 1,359 ± 1,036 pg/ml than the 292 ± 372 pg/ml of the 19 PPTH. Measured vitamin D of 1, 25(OH)2D was higher in the nine PPTH (88.0 ± 34.7 pg/ml) than in the 46 SPTH (15.5 ± 13.9). High serum amylase of >350 IU/l and cyst formations were found in ten (18%) and 16 (29%) of the SPTH but none of the PPTH. At least ten (18%) of the SPTH had polycystic kidney disease (PKD). Saliva-type amylase of the SPTH resolved the high I-PTH. High levels (>6.0%) of Hb A1C (8.1%) were measured only in one SPTH case with mediastinal ectopic SPTH and PKD. High urine 17 ketosteroid (17 KS) levels of 161.5 ± 72.9 mg/l were measured in three virilizing carcinomas with metastases to the bone, liver, and/or lung. Low-grade feminizing carcinoma was observed in a 6-year-old boy. Cysts of the kidney and/or liver were found in 17 (74%) with Cushing’s syndrome, 12 (40%) with primary aldosteronism, and three (43%) with pheochromocytoma. One paraganglioma had liver and pancreatic cysts, and one schwannoma had polycystic ovary. High levels of Hb A1C were detected in six (26%) with Cushing’s syndrome, five (17%) with primary aldosteronism showing insulinoma, and two (29%) with pheochromocytoma. In all 13 patients with diabetes mellitus (DM), AE was an effective DM treatment.