Common Cause Of Primary Hyperparathyroidism Research Articles

Mediastinal Paratiroid Adenomlarında Parsiyel Sternotomi Uygulaması

Background: Solitary parathyroid adenomas are the most common cause of primary hyperparathyroidism. Generally neck exploration is adequate for parathyroid adenoma surgery, however some of them aren’t accessible using a cervical approach and sternotomy or thoracotomy can be required. In this study we present surgical application of eight cases with mediastinal parathyroid adenoma. Material and Methods: Between Jan 2006 - Mar 2018, eight patients who underwent partial sternotomy for mediastinal parathyroid adenoma in our clinic were included in the study. Patients' datas were retrospectively reviewed. Blood tests, radiographic and scintigraphic methods were performed and the results were reviewed. Localization of mediastinal parathyroid adenoma, performed treatment methods and prognosis were evaluated.Results: Seven of the cases were female (87.5%) and the mean age was found to be 49.7 years (range: 30-64 years). Bone pain what’s the most common symptom. All of the patients experienced hypercalcemia and hyperparathyroidia. PTH and Ca values returned to normal in postoperative period. No recurrent or consistent hyperparathyroidism was seen during follow-up period. No postsurgical morbidity or mortality developed. Conclusion: We claimed that partial sternotomy is a safe and adequate method for removing ectopic mediastinal parathyroid adenomas.

A Case Report on Recurrent Acute Pancreatitis with Primary Hyperparathyroidism

Pancreatitis is a common non-bacterial inflammatory disease caused by activation, interstitial liberation and auto digestion of pancreas by its own enzymes. Common causes of acute pancreatitis are gall stones, alcohol, drugs, trauma, viral infections and hypertriglyceridemia. Much is known about the causes of pancreatitis but huge experimental data available about understanding of its pathogenesis is still incomplete. Hypercalcemia as a cause of pancreatitis is rarely reported. Hypercalcemia is usually the result of Primary hyperparathyroidism (PHPT) and the most common cause of PHPT is parathyroid adenoma. It is thought that the increased calcium concentration in pancreatic juice resulting from hypercalcemia may prematurely activate proteases. Mutations in different genes have been proposed as well to justify why only some patients with primary hyperparathyroidism and hypercalcemia develop acute pancreatitis. Here we present a case of recurrent acute pancreatitis resulting from hypercalcemia due to parathyroid adenoma in a 38-year-old man. Hyperparathyroidism was suspected when despite severe pancreatitis calcium level remained high and parathormone level was grossly raisedFaridpur Med. Coll. J. Jan 2016;11(1): 36-38

가역적 성대마비의 원인이 된 비활성 부갑상선 선종 1예

Parathyroid adenoma is the most common cause of primary hyperparathyroidism with symptoms of fatigue, bone pain, abdominal pain, weakness, dyspepsia, and skeletal bone disease. However, vocal cord paralysis caused by parathyroid adenoma is extremely rare. A 72-year-old male presented with intermittent voice change for 10 years. Laryngeal endoscopy showed right vocal cord paralysis. Computed tomography revealed a 4 mm sized lesion behind of right thyroid. Fine needle aspiration was undertaken and the histology result was a parathyroid adenoma. We excised the parathyroid adenoma adjacent to the right recurrent laryngeal nerve. After excision of parathyroid adenoma, vocal cord paralysis has returned to normal. The patient is under observation for 6 months without recurrence. We report our experience of one rare case of parathyroid adenoma as a cause of vocal cord paralysis. (J Clinical Otolaryngol 2016;27:401-404)

Crippling bone deformities and a palpable neck lump; rare presentation of a giant parathyroid adenoma

The most common cause of primary hyperparathyroidism is a solitary parathyroid adenoma. The different manifestations of the disease are due to excess parathyroid hormone (PTH) secretion. Giant parathyroid weigh more than 2 g and are rarely evident in clinical examination. We present a young man who presented with severe bone deformities and a palpable neck lump. After surgery, a giant parathyroid adenoma was removed that weighed 33 g. Adenomas weighing more then 30 g are rare and presentation as a neck lump and severe bone disease has seldom been described. In patients presenting with a palpable neck lump, severe bone disease and renal calculi giant parathyroid adenomas should be considered as a possible culprit.

Optimal scan time for evaluation of parathyroid adenoma with [(18)F]-fluorocholine PET/CT.

BackgroundParathyroid adenomas, the most common cause of primary hyperparathyroidism, are benign tumours which autonomously produce and secrete parathyroid hormone. [18F]-fluorocholine (FCH), PET marker of cellular proliferation, was recently demonstrated to accumulate in lesions representing enlarged parathyroid tissue; however, the optimal time to perform FCH PET/CT after FCH administration is not known. The aim of this study was to determine the optimal scan time of FCH PET/CT in patients with primary hyperparathyroidism.Patients and methods.43 patients with primary hyperparathyroidism were enrolled in this study. A triple-phase PET/CT imaging was performed five minutes, one and two hours after the administration of FCH. Regions of interest (ROI) were placed in lesions representing enlarged parathyroid tissue and thyroid tissue. Standardized uptake value (SUVmean), retention index and lesion contrast for parathyroid and thyroid tissue were calculated.ResultsAccumulation of FCH was higher in lesions representing enlarged parathyroid tissue in comparison to the thyroid tissue with significantly higher SUVmean in the second and in the third phase (p < 0.0001). Average retention index decreased significantly between the first and the second phase and increased significantly between the second and the third phase in lesions representing enlarged parathyroid tissue and decreased significantly over all three phases in thyroid tissue (p< 0.0001). The lesion contrast of lesions representing enlarged parathyroid tissue and thyroid tissue was significantly better in the second and the third phase compared to the first phase (p < 0.05).ConclusionsAccording to the results the optimal scan time of FCH PET/CT for localization of lesions representing enlarged parathyroid tissue is one hour after administration of the FCH.

A large parathyroid adenoma presenting with pathological fractures in a young male

&lt;p class="abstract"&gt;&lt;span lang="EN-US"&gt;Parathyroid adenoma is the common cause of primary hyperparathyroidism and usually presents with features of hypercalcaemia. In the present case report, we describe a case of a large adenoma of the parathyroid gland presenting with pathological fractures. A 42 year old Male presented with bony pains and fracture of the left humerus after a trivial trauma. A detailed clinical examination and laboratory studies revealed hypercalcaemia secondary to hyperparathyroidism. The patient underwent targeted parathyroidectomy of the involved gland after appropriate preoperative localization. Histopathology of the resected specimen was consistent with parathyroid adenoma. Conclusion&lt;strong&gt; &lt;/strong&gt;is a common cause of primary hyperparathyroidism is a common endocrine disorder occurring as a result of Parathyroid adenoma in 80-85% cases. Patients usually present with symptoms related to hypercalcaemia. A high index of suspicion, careful preoperative workup, localization of the affected gland(s) and surgical excision ensures a successful cure.&lt;/span&gt;&lt;/p&gt;

Functioning lipoadenoma of parathyroid in ectopic location

Parathyroid adenoma is the most common cause of primary hyperparathyroidism. Parathyroid lipoadenoma is a rare and well-documented clinico-histological variant of parathyroid adenoma which owing to its bulky nature is found at aberrant locations and generally extends into the mediastinum, thus posing difficulty in diagnosis and surgical exploration. Here we present a young lady with classical signs and symptoms of primary hyper-parathyroidism who underwent excision of the single adenoma, and histologically diagnosed as a lipoadenoma. Here, we discuss the presentation and management of this rare variant.

Pre-operative localisation of parathyroid adenomas

Background: A solitary adenoma is the most common cause of primary hyperparathyroidism. Accurate pre-operative localisation can result in the implementation of minimally invasive surgery subsequently improving patient outcome and reducing cost. Dual imaging techniques can improve sensitivity of localisation of parathyroid adenoma.

Lipoadenoma of parathyroid gland : report of a rare case

AbstractParathyroid adenoma is a rare disease. It is the most common cause of primary hyperparathyroidism. Patients are commonly mis-diagnosed and treated symptomatically rather than addressing the main cause. Parathyroid lipo-adenoma is a rare clinico-histological variant of parathyroid adenoma which owing to its bulky nature is found at aberrant locations and generally extends into the mediastinum, thus posing difficulty in diagnosis and surgical exploration. Here we present a young lady with classical signs and symptoms of primary hyper-parathyroidism who underwent excision of the single adenoma, and histologically was a lipoadenoma. This case report highlights the importance of appropriate pre-operative and intra-operative planning and execution for better recovery of the patients.

Diagnostic value of endoscopic ultrasonography for preoperative localization of parathyroid adenomas

The most common cause of primary hyperparathyroidism (PHPT) is a single, sporadic parathyroid adenoma. Ultrasonography (US) and (99m)Technetium methoxyisobutylisonitrile ((99m)Tc-MIBI) scintigraphy are the imaging methods most widely used to localize parathyroid adenomas. The purpose of the present study was to determine the diagnostic value and accuracy of endoscopic ultrasonography (EUS) for localizing parathyroid adenoma compared with those of US and (99m)Tc-MIBI scintigraphy. Forty-seven patients with a PHPT diagnosis and who were recommended for surgery were enrolled in this study. An endoscopist who was blinded to the previous US and (99m)Tc-MIBI scintigraphy results performed the EUS in each patient. Thirty-nine female and eight male patients with PHPT were evaluated. The presence of adenoma was confirmed by subsequent postsurgical pathology results. One case was excluded because the histopathological evaluation was compatible with a lymph node, although the lesion was detected using three different imaging modalities preoperatively. The locations of the parathyroid adenomas were correctly documented by US in 39 patients (84.7 %) by (99m)Tc-MIBI scintigraphy in 35 (76.0 %), and by EUS in 44 (95.6 %) of 46 patients. EUS located all 31 adenomas detected previously with US and (99m)Tc-MIBI scintigraphy. EUS also successfully located three adenomas that could not be identified by US and (99m)Tc-MIBI scintigraphy. The positive predictive value and diagnostic accuracy of EUS, US, and (99m)Tc-MIBI were 97.7, 97.7, and 95.6 %; 88.6, 97.5, and 86.9 %; and 77.7, 97.2, 76.0 %, respectively. EUS was preferred as the second step imaging tool for detecting parathyroid adenomas that could not be localized by US and (99m)Tc-MIBI scintigraphy.

A Rare Cause of Primary Hyperparathyroidism Presented with Giant Adenoma, Multiple Brown Tumors And End Stage Renal Failure

Abstract Single gland adenoma is the most common cause of primary hyperparathyroidism (PHPT). Although PHPT is generally an asymptomatic disease detected by an incidental finding of hypercalcemia, overt skeletal disease, renal failure and huge adenoma that cause local pressure can be seen seldomly in neglected cases. We report a case of a parathyroid adenoma weighing 116 g (normal weight 25 - 40 mgs) causing multiple brown tumors, renal failure and refractory anemia. Key Words: Giant parathyroid adenoma, primary hyperparathyroidism, brown tumor, chronic renal failure

11. Chronic parathyroiditis in a parathyroid adenoma: a frozen section challenge

Parathyroid adenoma is the most common cause of primary hyper-parathyroidism. Autoimmune thyroiditis occurring together with parathyroid adenoma is well documented, however few cases of chronic parathyroiditis, coexisiting with parathyroid adenoma and autoimmune thyroiditis, have been reported. We present a case of parathyroid adenoma with chronic parathy-roiditis, presenting for frozen section diagnosis, in a patient with hyperparathyroidism and autoimmune thyroiditis. The patient was a 54-year-old man presenting with a 6 month history of fatigue and lethargy. Investigation revealed serum hyper-calcaemia together with hyperparathyroidism. Thyroid function tests noted a mild increase in thyroid hormones, together with elevated thyroid antibodies. The patient underwent imaging with a parathyroid isotope scan, identifying a focal area of increased uptake consistent with an adenoma. A parathyroidectomy was performed with intraoperative frozen section diagnosis. Two specimens were received for frozen section. The frozen section was challenging as both showed glands admixed with lymphoid cells. No atypical nuclear features were noted. Further details obtained during frozen section revealed a history of thyroiditis. The presumptive diagnosis was possible thyroid inclusions in a lymph node or Hashimoto's thyroiditis. A definitive diagnosis was deferred. Paraffin sections revealed encapsulated glandular tissue with features consistent with a parathyroid adenoma. There was a moderately dense lymphoid infiltrate with lymphoid follicles showing germinal centres. Immunohistochemistry confirmed parathyroid tissue. The fi-nal diagnosis was parathyroid adenoma with chronic parathyroiditis. This case presents a possible pitfall particularly on frozen section. While microscopic examination of parathyroid adenomas often reveals scattered lymphocytes, a lymphoid infiltrate with lymphoid follicles is rarely seen. It is important to consider chronic parathy-roiditis as a differential in the setting of a parathyroid adenoma and autoimmune thyroiditis.

Chief cell and clear cell parathyroid adenoma do not influence clinical and biochemical expression of the sporadic primary hyperparathyroidism

Primary hyperparathyroidism (PHPT) is a common endocrine disorder and the most common cause of PHPT is parathyroid adenoma [1]. The normal parathyroid gland is composed of three types of cells—chief (50–60 %), clear (30–40 %), and oxyphil cells (\5 %) [2]. The chief cells have slightly eosinophilic cytoplasm and contain few mitochondria and these cells mainly secrete parathyroid hormone (PTH) [2]. Clear cells, which contain excessive cytoplasmic glycogen, are formed from chief cells while oxyphil cells have an intensely eosinophilic cytoplasm enriched with numerous and tightly packed mitochondria [3]. The function of clear and oxyphil cells is still not clear [2, 3]. Though the exact percentage of various cell types of adenoma is not known, chief cell adenoma is documented to be the most common cause of PHPT [4]. Since the chief cells are the principle cells secreting PTH, chief cell adenoma is expected to present with classical symptoms of PHPT. The clinical and biochemical presentation of clear cell adenoma is not known. There are few case reports of water clear cell adenoma presenting with classical symptoms of PHPT and these cells are positive for PTH immunostaining [5–8]. Furthermore, there is no study in the literature to compare the clinical and biochemical parameters of PHPT between chief cell and clear cell parathyroid adenoma. Considering these lacunae in literature, the present study was planned.

Feasibility of Rapid Parathormone Assay for Enabling Minimally Invasive Parathyroid Excision

There is no doubt that the success of minimally invasive parathyroidectomy (MIP) has changed the whole treatment of patients with primary hyperparathyroidism, especially the approach towards traditional bilateral neck exploration. A single adenoma is the most common cause of primary hyperparathyroidism and its removal results in cure. Hence, it is worth the effort to localise and excise the single adenoma using modern technologies such as high-quality sestamibi scans and to confirm complete excision using rapid intra operative parathormone (IOPTH) assays. The objective of the study was to evaluate the feasibility of rapid IOPTH assay in successfully facilitating minimally invasive parathyroid excision. This research involved the retrospective study of seven patients, who underwent MIP at Sagar Hospital in Bengaluru, India, for parathyroid adenoma. All patients with evidence of unifocal disease on sestamibi scanning and cervical ultrasonography, underwent MIP via 2-3cm lateral incision. Blood samples for measurement of IOPTH were taken at the time of induction of anaesthesia and 10min after the adenoma excision. Reduction of parathormone (PTH) levels of more than 50% in the postexcision sample was taken as evidence for complete extirpation of parathyroid adenoma. A solitary adenoma was identified in all the seven patients. After MIP, IOPTH levels fell in six of the seven patients. Following the surgery, all the cases were followed up for a period of 1month. During this time, except for one patient, six patients remained asymptomatic and blood tests revealed normal serum calcium levels. A histopathological examination confirmed the diagnosis of parathyroid adenoma in six of the seven patients. After accurate preoperative localisation of the adenoma in patients with primary hyperparathyroidism, MIP with IOPTH measurement offers a safe and successful outcome.

Solitary phalangeal brown tumour in primary hyperparathyroidism: Report of a rare presentation

Parathyroid adenoma is the most common cause of primary hyperparathyroidism. Severe cases of primary hyperparathyroidism manifest as osteitis fibrosa cystica generalisata, characterized by generalized bone loss with increased bone resorption, including both subperiosteal and endosteal surfaces. The most common sites for formation of fibrotic cystic lesions (brown tumors) are in the long bones and jaw which present as swelling, pathological fracture, and/or bone pain, usually involving multiple sites. Here, we describe an unusual presentation of a solitary brown tumor in a young male who initially presented to the hand surgeon with a history of right thumb swelling following trivial trauma. Further detailed clinical, biochemical, scintigraphic (Tc 99m methylene diphosphonate scintigraphy and Tc 99m Sestamibi scintigraphy), and radiological investigations aided definitive diagnosis and treatment. The causative parathyroid adenoma was excised curing hyperparathyroidism and the lesion regressed substantially.

Morphological evaluation of parathyroid adenomas and immunohistochemical analysis of pcna and ki-67 proliferation markers

Parathyroid adenomas are the most common cause of primary hyperparathyroidism. Biological studies have shown that parathyroid adenomas are monoclonal proliferations. Up to date, five cell types have been identified in normal parathyroid tissues; chief cells, vacuolated chief cells, dark chief cells, oxyphil cells and transitional oxyphil cells. Most parathyroid adenomas are predominantly composed of chief cells. In this study, we aimed to indicate the relationship between the predominant cell type in parathyroid adenomas and proliferating cell nuclear antigen, Ki-67 antigen, and serum parathormone levels and the gland weight. 15 cases who had a diagnosis of parathyroid adenomas were included in the study. Histopathologically, the predominant cell type was determined in all the cases. Paraffin blocks were immunohistochemically stained with proliferating cell nuclear antigen and Ki-67. The average parathormone level of the cases was 239.52 ± 36.61 pg/ml before surgery. Mean gland weight was 1.69 ± 0.49 g. Two of the cases showed atypical adenoma characteristics. The predominant cell type was vacuolated chief cell. Immunohistochemical investigation showed that the mean average Ki-67 index value was 4.26 ± 0.86%. The mean proliferating cell nuclear antigen index was 93.20± 45.72/10³. There was a meaningful relationship between gland weights and serum parathormone levels. There was no meaningful relationship between predominant cell types and serum parathormone levels, proliferating cell nuclear antigen index, and Ki-67 index. The chief cell was identified as the predominant cell type. It can be concluded that parathyroid adenomas come into existence as a result of neoplastic proliferation of chief cells, especially vacuolated chief cells.

Parathyroid Adenoma as a Cause of Vocal Fold Paralysis

Parathyroid adenomas (PAs) are the most common cause of primary hyperparathyroidism. Presentations can range from the classic bone pain, depression, fatigue, renal calculi, and gastrointestinal tract symptoms to asymptomatic calcium level elevation detectedonaserumchemistrypanel.Theyarebenigntumorsthatarenotgenerallythought to cause recurrent laryngeal nerve paralysis.

Substernal oxyphil parathyroid adenoma producing PTHrP with hypercalcemia and normal PTH level

BackgroundParathyroid adenoma is the most common cause of primary hyperparathyroidism. Preoperative serum calcium and intact-parathyroid hormone levels are the most useful diagnostic parameters that allow differentiating primary hyperparathyroidism from non-parathyroid-dependent hypercalcemia. Parathyroidectomy is the definitive treatment for primary hyperparathyroidism. Approximately 5% of patients who underwent parathyroidectomy present with persistent or recurrent hyperparathyroidism due to ectopic localization of the adenoma. Functioning oxyphil parathyroid adenoma is an uncommon histological form, seldom causing primary hyperparathyroidism. Parathyroid adenoma with hypercalcemia exhibiting normal parathyroid hormone level is rare. An incidence of 5% to 33% has been documented in the literature; no etiologic explanation has been given. In 1987, parathyroid-hormone-related peptide was isolated as a causative factor of humeral hypercalcemia of malignancy. The presence of parathyroid-hormone-related peptide in parathyroid tissue under normal and pathological conditions has been described in the literature; however, its role in causing hyperparathyroidism has not yet been defined.Case presentationWe present a case of persistent hypercalcemia with a normal level of intact-parathyroid hormone due to a substernal parathyroid adenoma, treated with radioguided parathyroidectomy. The final histological diagnosis was oxyphil adenoma, positive for parathyroid-hormone-related peptide antigens.ConclusionIn clinical practice, this atypical biochemical presentation of primary hyperparathyroidism should be considered in the differential diagnosis of hypercalcemia. The parathyroid-hormone-related peptide should be considered not only in the presence of malignancy.

Primary Hyperparathyroidism in Dogs and Cats

The most common cause of primary hyperparathyroidism in dogs and cats is a solitary adenoma involving an extracapsular parathyroid gland. The prognosis is excellent if the affected parathyroid gland is removed. Nonsurgical methods are discussed, although there are no current data to support any benefit over conventional surgery. The common postoperative complication to consider is hypocalcemia. Hypocalcemia can be successfully managed in these animals if it is anticipated and treated promptly.

High resolution MRI in the detection of an intrathymic parathyroid adenoma

The most common cause of primary hyperparathyroidism is parathyroid adenoma. Of these, up to 20% have been reported to be in ectopic locations. Multiple imaging techniques have been utilized in the detection of ectopic adenoma and are discussed. We report on a case of an intrathymic parathyroid adenoma that was detected through the novel use of a breast coil in performing a high resolution MRI. The accurate localization permitted minimally invasive surgery, obviating morbidity associated with a sternotomy.