Parathyroid Adenoma: Diverse Modalities of Clinical Presentation. Series of Cases and Literature Review. January 2010-October 2020

Abstract

The surgical treatment of Parathyroid Disease (PD) has change in the past two decades. The Parathyroid Adenoma (PA) represents 80%, some with symptoms others asymptomatic. The technological development of imaging methods has allowed greater precision in planning the surgical approach. The goal of parathyroidectomy is to cure. There are several surgical approaches from open cervical to minimal endoscopic surgery. Objective: The main of this study is to present the clinical characteristic, the diagnosis methods: biochemical and imaging, surgical approached and follow up. Methods: Descriptive study, Cohort, Series of cases. We reviewed the record of 450 patients diagnosed with tumor in head and neck during the period January 2010 to October 2020. We selected the record of patients with diagnosed of PA and the clinical characteristics of the patients according demographic aspect, symptoms, biochemical and imaging methods, complementary diagnosis test, surgical approach, histological classification according WHO Tumor of Endocrine Organs 4th edition 2017. The frozen section during the surgery indicted with the freezing microtome and stained with hematoxylin and eosin. The univariable review realized with frequency and percentage using Excel 2016. Results: We selected 6 (1.3%) patients, male 5(83%) female 1(17%). The age range was 28-72 years, the median ages 49.6 in the neck located 4(66%), 1(17%) in upper mediastinum and 1(17%) in cervical and thoracic location. patient with recurrence after of five years. 1 with three PA and 1 with two PA. The parathyroid gland affected was: lower right 3 cases, upper left 1, lower left 5 cases and one upper mediastinum. The symptoms were nephrocalcinosis and chronic kidney failure (CKF) 4 patients, bone loss (spine/hip) 2, cardiovascular diseases 1, left neck swelling and disphagia 1. Imaging methods used: ultrasonography and technetium-99 Sestamibi Scanning the 5 patients, Magnetic Resonance Imaging (MRI) 4 and CT Scann 1 The bone densitometry: 2 (33%) patients with severe osteoporosis, 2(33%) with moderate, 1(16%) normal and 1 unknown. The surgical approach was: bilateral cervical exploration 2 patients, unilateral cervical exploration 2, minimally invasive thoracoscopic 1 and double cervical and thoracic open 1. The biochemical control of parathyroid hormone (PTH) was: range prior surgery 384-3000 pg/ML the mean 1,730.2 pg/ML. The percentage of decrease post-surgery was 99 %-98% Calcium prior surgery was 9.2-14.09 mg/dl the mean 11.2 mg/dl the range post-surgery was: 7.9-9.9 mg/dl the mean 8.6 mg/ dl. Pathology register reveled PA, 5(83%) and 1(17%) a giant nonfunctioning Parathyroid cyst. During the follow up, only 1 patient presented recurrence five years later and required reintervention. None with post-surgery complication. Conclusions: The multidisciplinary approach permitted the success obtained and surgery planning for each patient with PA. The results show like other papers, which using the technological development of imaging studies, the support of the frozen biopsy for the lack of PTH fast, allowed to corroborate the surgical remotion of the diseases gland with high percentage of cure.