An Approach to a Patient With Primary Hyperparathyroidism and a Suspected Ectopic Parathyroid Adenoma.

Abstract

Primary hyperparathyroidism (PHPT) is characterized by hypercalcemia driven by excess parathyroid hormone (PTH) secretion. PHPT is a common endocrine condition with a prevalence of 1 to 7 cases per 1000 adults. PHPT typically presents in the fifth or sixth decade and shows significant female preponderance. Solitary hyperfunctioning parathyroid adenomas account for 85% to 90% of PHPT cases. The remaining 10% to 15% include cases of multiglandular disease (multiple adenomas or hyperplasia) and, rarely, parathyroid carcinoma (1%). Ectopic parathyroid adenomas may arise due to abnormal embryological migration of the parathyroid glands and can be difficult to localize preoperatively, making surgical cure challenging on the first attempt. The potential existence of multiglandular disease should be considered in all patients in whom preoperative localization fails to identify a target adenoma or following unsuccessful parathyroidectomy. Risk factors for multiglandular disease include underlying genetic syndromes (eg, MEN1/2A), lithium therapy, or previous radiotherapy. In addition to multifocal disease, the possibility of an ectopic parathyroid gland should also be considered in patients requiring repeat parathyroid surgery. In this article, we use illustrative clinical vignettes to discuss the approach to a patient with primary hyperparathyroidism (PHPT) and a suspected ectopic parathyroid adenoma.

• Authors: Clark Glasgow, Eunice Y C Lau, Luigi Aloj, Ines Harper, Heok Cheow, Tilak Das, Laurence Berman, Andrew S Powlson, Waiel A Bashari, Benjamin G Challis, Alison Marker, Penelope Moyle, Isra Ahmed Mohamed, Nadia Schoenmakers, Jonathan Broomfield, Sue Oddy, Carla Moran, Mark Gurnell, Piyush Jani, Liam Masterson, Brian Fish, Ruth T Casey
• Journal: The Journal of clinical endocrinology and metabolism (J Clin Endocrinol Metab) Vol. 107 Issue 6 Pg. 1706-1713 (05 17 2022) ISSN: 1945-7197 [Electronic] United States
• PMID: 35150267 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © The Author(s) 2022. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: [email protected].

Chemical References

• Parathyroid Hormone

Topics

• Adenoma (complications, diagnosis, surgery)
• Adult
• Female
• Humans
• Hyperparathyroidism, Primary (complications, diagnosis)
• Parathyroid Glands (surgery)
• Parathyroid Hormone
• Parathyroid Neoplasms (complications, diagnosis, surgery)
• Parathyroidectomy (adverse effects)