Endocrine Abstracts

We present two case reports of patients who were diagnosed with hyperparathyroidism based on a parathyroid gland adenoma (PTA). The pathological parathyroid tissue was precisely localised by ultrasonography and scintigraphy before the surgery. In both cases all four parathyroid glands were revised by the surgeon resulting in an operation extension. Another parathyroid gland was removed and histologically confirmed as PTA. This surgeon’s approach was beneficial for the patient and the operation procedure was therefore curative.

The first patient (male, 72 years old) was diagnosed with hyperparathyroidism in 10/2012. Ultrasonography showed a goiter with a solitary cystic nodule in the right lobe. Scintigraphy did not show any hyperfunctional parathyroid tissue. In the cystic fluid from the nodule we measured very high concentration of parathormone. Next sonography after the evacuation of the cystic fluid showed a typical hypoechoic right inferior PTA. The patient was recommended for a total thyroidectomy and extirpation of the right inferior PTA. After the operation in 2/2014 the pathologist surprisingly did not describe any parathyroid tissue within or next to the right lobe of the thyroid gland. Moreover, the surgeon found left superior PTA that was confirmed histologically!

The second patient (female, 77 years old) was diagnosed with a hyperparathyroidism in 6/2015. Ultrasonography showed two suspicious hypoechoic nodules under the left lobe. Scintigraphy revealed two PTAs – right inferior and left superior. The patient was recommended for a surgery too. The surgeon unsurprisingly removed left superior PTA, but he had doubts about the right inferior parathyroid gland that was only partially respected and histologically confirmed as a normal tissue! Moreover, the surgeon removed right superior PTA (confirmed histologically)!

Those two case reports highlight the important role of an intraoperative revision of all parathyroid glands.