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Fulltext Primary hyperparathyroidism--a surgical review of 12 cases

Meah FA, Tan TT, Taha A, Khalid BA

Med J Malaysia, 1991 Jun;46(2):144-9.
PMID: 1839418

Twelve cases of primary hyperparathyroidism operated by the Universiti Kebangsaan Malaysia Surgical Team from 1978 to 1989 were reviewed. There was a preponderance of Indian females in this series. The majority of the cases presented late and with complications. Renal calculi and bone disease were the commonest complications noted. Of the 12 patients, 9 had single parathyroid adenoma of which 4 were ectopically located, and 2 had hyperplasia of the parathyroids. These were all successfully operated. The remaining patient had 2 failed neck explorations. Failure at initial exploration was due to ectopic location of the glands. Meticulous surgical technique, knowledge of the anatomical variations of location of the parathyroid glands and availability of frozen section facility are essential for successful outcome.

Matched MeSH terms: Parathyroid Neoplasms/diagnosis
Fulltext Parathyroid carcinoma in a 30-year-old man: a diagnostic and management challenge

Ng SH, Lang BH

World J Surg Oncol, 2013;11:83.
PMID: 23566353 DOI: 10.1186/1477-7819-11-83

Parathyroid carcinoma is a rare endocrine malignancy, accounting for less than 1% of cases of primary hyperparathyroidism. Patient-related factors such as age and sex, as well as the biological features and management of the cancer, influence mid-term and long-term survival. We report a case of a young man with an unusual presentation of parathyroid carcinoma. The patient presented with left thigh swelling, which had been present for 6 months without other symptoms of hypercalcemia. On computed tomography scan a hypodense lesion, 30 × 20 × 20 mm in size, was seen in the posterior thyroid. There was no evidence of cervical lymphadenopathy or local infiltration. On a Sestamibi scan, a hot spot was seen in the lower pole of left thyroid lobe. Cervical neck exploration was performed. The patient subsequently underwent surgery and a parathyroid tumor was excised. The tumor was adherent to the thyroid capsule, but there was no evidence of invasion. After surgery, the patient's calcium and parathyroid hormone levels normalized, but histology confirmed parathyroid carcinoma with capsular and vascular invasion. The patient was offered reoperation, but declined, and developed recurrent parathyroid carcinoma 2 years later. In this report, we aim to present the challenges in managing parathyroid carcinoma and discuss factors that might contribute to future locoregional recurrences. This case also highlighted several issues, including the challenge of ascertaining the diagnosis before surgery and the dilemma of reoperation after simple excision.

Matched MeSH terms: Parathyroid Neoplasms/diagnosis
Large retrosternal parathyroid carcinoma with primary hyperparathyroidism

Tan GC, Shiran MS, Swaminathan M, Phang KS, Rohaizak M

Asian J Surg, 2007 Oct;30(4):286-9.
PMID: 17962134

Parathyroid carcinoma is an uncommon cause of parathyroid hormone (PTH)-dependent hypercalcaemia, accounting for less than 1% of all cases of hyperparathyroidism. Parathyroid carcinoma is an indolent tumour with rather low malignant potential. Consideration of parathyroid carcinoma in the differential diagnosis of hypercalcaemic disorders is important because the morbidity and mortality are substantial and the best prognosis is associated with early recognition and surgical resection. Clinical indicators favouring parathyroid carcinoma over benign disease include markedly raised serum calcium levels, PTH and alkaline phosphatase. A palpable neck mass with both kidney and skeletal manifestations also give a high index of suspicion of parathyroid carcinoma. Histopathology alone is not sufficient to diagnose parathyroid cancer; it has to be correlated with the clinical findings. The initial and most effective treatment for parathyroid carcinoma is complete resection of the primary lesion, and repeated operations for recurrence are useful. The prognosis of parathyroid carcinomas is quite variable; 5-year survival rates vary from 40% to 86%, while the 10-year survival rate is approximately 49%. We report a case of parathyroid carcinoma occurring in a 55-year-old woman who presented with bone pain and hypercalcaemia.

Matched MeSH terms: Parathyroid Neoplasms/diagnosis
Fulltext Primary hyperparathyroidism with carcinoma of the right breast--a case report

Muin IA, Meah FA

Med J Malaysia, 1994 Sep;49(3):301-2.
PMID: 7845286

A patient with carcinoma of the right breast and coincidental primary hyperparathyroidism is presented. The distinction between hypercalcemia of malignant and hyperparathyroid origins is based on biochemical analysis and localisation of parathyroid adenoma on a computer tomogram of the neck.

Matched MeSH terms: Parathyroid Neoplasms/diagnosis
A case report of primary hyperparathyroidism with severe bony involvement and nephrolithiasis

Chan SP, Hew FL, Jayaram G, Kumar G, Chang KW, Tay A

Ann Acad Med Singap, 2001 Jan;30(1):66-70.
PMID: 11242630

INTRODUCTION: Although the majority of patients with primary hyperparathyroidism have a relatively asymptomatic benign disorder, there are patients who have a more aggressive disorder.
CLINICAL PICTURE: We report a case of primary hyperparathyroidism presenting during pregnancy complicated by antepartum haemorrhage and severe prematurity. The diagnosis was made postpartum, when her problems rapidly progressed to result in severe neuromuscular weakness, bilateral pathological hip fractures as well as nephrolithiasis.
TREATMENT: Surgical parathyroidectomy was performed. The underlying lesion was a large solitary parathyroid adenoma with cystic elements.
CONCLUSION: Primary hyperparathyroidism is not an innocuous disease and can result in severe morbidity if left untreated.

Matched MeSH terms: Parathyroid Neoplasms/diagnosis*
Fulltext Mediastinal parathyroid adenoma: diagnostic and management challenges

Che Kadir S, Mustaffa BE, Ghazali Z, Hasan Z, Imisairi AH, Mustafa S

Singapore Med J, 2011 Apr;52(4):e70-4.
PMID: 21552777

Primary hyperparathyroidism due to ectopic parathyroid adenomas can pose diagnostic and management challenges, especially when imaging studies have localised the lesions to different sites. We report a case of symptomatic hypercalcaemia due to a mediastinal parathyroid adenoma. Ultrasonography identified a nodule posterior to the right thyroid gland. However, computed tomography and technetium-99m sestamibi scintigraphy revealed an ectopic parathyroid adenoma located in the anterior mediastinum. The adenoma was successfully removed through a median sternotomy. However, postoperatively, the patient developed prolonged symptomatic hypocalcaemia, possibly due to suppression of the normal parathyroid gland function, although the presence of concomitant hungry bone syndrome was possible. The histopathology of the mediastinal mass was consistent with a parathyroid adenoma.

Matched MeSH terms: Parathyroid Neoplasms/diagnosis*