Endocrine Abstracts

Background: Parathyroid adenomas represent the most common anatomoclinical variety of hyperparathyroidism.

Material and method: From our experience of 84 cases of hyperparathyroidism – 20 primary and 64 ‘renal’ (CKD-MBD) – 18 patients underwent surgery for solitary adenomas of these glands. Clinical data, laboratory and imaging test results, surgical procedures and outcome were comprehensively analysed.

Results: We registered 16 women and only two men, aged between 16–58 (mean 46) years. From the clinical point of view bone manifestations prevailed in six cases, those of urolithiasis in nine cases and pancreatic phenomena in two cases. One patient was asymptomatic being discovered incidentally during a thyroidectomy. The mean serum calcium at the time of diagnosis was 11.5±2.2 mg/dl but serun phosphorus was 4.4±0.5 mg/dl. The mean parathyroid hormone (PTH) level (measured in only 12 patients) ranged between 127–778 pg/ml. Ultrasonography acurately identified lesions in 16 cases and Technetium=99 m sestamibi scintigra-phy in only five cases. Eighteen adenomectomies were performed of which bilateral neck exploration was done in 16 patients and minimally invasive approach in the remaining two cases. In seven situations concomitant thyroid exeresis were done for associated lesions or imposed by tactical purpose. Pathologic examination revealed single adenoma consisting of main and oxyphil cells in 17 cases. In one patient an atypical adenoma was identified and in another case 3 years after removal of a benign adenoma the subject presented a homolateral clinical recurrence, which proved to be a carcinoma (new lesion or erroneous initial diagnosis?). Postoperative clinical and humoral outcome was favorable in all situations excepting the case with carcinoma which died after 14 months.

Discussions and conclusions: Parathyroid adenomas produced evident systemic clinical features but not always easy to diagnose. They benefit significantly from surgical treatment which is considered the gold standard of respective lesions.