Endocrine Abstracts

Introduction: In 80–90% of cases, the cause of sporadic primary hyperparathyroidism is adenoma of one parathyroid gland. Multiple-gland disease (MGD) is defined in patients with more than one pathological parathyroid gland. The frequency of occurrence of MGD is from 7% to 33%.Our aim is to report a case of primary hyperparathyroidism with MGD and to describe its diagnostic and therapeutic features.

Case Report: A 55-year-old man presented with 1-year history of bone pain and asthenia. He had history of diabetes and hypertension. He had not been suffering from pathological fractures, nephrolithiasis or gastropathy. No familial history of multiple endocrine neoplasia syndrome was noted. Physical exam showed a 2-cm left anterior neck mass.The laboratory workup revealed: serum calcium level was 3.05 mmol/l, serum phosphate level was 0.99 mmol/l, and serum PTH level was 127 ng/l. Ultrasonography of the neck revealed a 26-mm parathyroid nodule behind the left lobe of the thyroid gland and another one behind the right lobe, measuring 15 mm. A 99 m technetium (99 mTc) sestamibi scan has been performed: it showed an inferior right parathyroid adenoma with doubt on another left adenoma.The patient underwent superior and inferior right parathyroidectomy and left inferior parathyroidectomy. The intra-operative examination suggested parathyroid adenomas. The postoperative course was uneventful. The level of serum PTH (43 ng/l) and serum calcium (2.45 mml/l) were normalized after the surgery. Histological exam confirmed the diagnosis of MGD: adenoma of the right superior parathyroid gland, pseudo adenomatous hyperplasia of the right inferior parathyroid gland and hyperplasia of the left inferior parathyroid gland.No recurrence was noted after 1 year of follow-up.

Conclusion: Identifying preoperatively patients at risk for MGD remains challenging. Intraoperative decisions are important for achieving acceptable cure rates and long-term follow-up is mandatory in such patients. Patients with MGD have an increased risk of complications at surgery and for persistence and recurrence after surgery.