CASE SERIES OF PRIMARY HYPERPARATHYROIDISM DUE TO GIANT PARATHYROID GLAND ADENOMA

AUTHORS:
A. Varona Mancilla (Tarragona, Spain) , E.D. Padilla Zegarra (Tarragona, Spain) , M. Vallvé-Bernal (Tarragona, Spain) , M. Abellán Lucas (Murcia, Spain) , A. Ilari Civit (Tarragona, Spain) , E. Goyda (Tarragona, Spain) , R. Casanova Marqués (Tarragona, Spain) , M. Rodrigo Rodrigo (Tarragona, Spain) , Á. Díaz Martin (Tarragona, Spain) , M. Defez Martin (Tarragona, Spain) , M. Castellote Caixal (Tarragona, Spain) , R. Jorba Martin (Tarragona, Spain)
Background:
There is a low consensus for the giant parathyroid gland adenoma diagnostic criteria. Some literature consider a giant parathyroid adenoma if the weight is greater than 3.5g, but other authors consider the size to be larger than 3cm. The aim of the study is to evaluate the experience with giant adenomas in our hospital.
Methods:
A descriptive, retrospective and longitudinal study was performed involving all the cases of giant parathyroid adenoma registered in the database of our endocrine surgery unit between 2015 and 2023.
Results:
15 cases of giant parathyroid adenoma were included. 9 met weight criterion and 12 met size criterion. 6 met both criteria. Largest measures, from the same patient, were 5cm and 3.4g. 5 patients had symptoms before surgery and all of them improved/disappeared after surgery. 2 patients had osteitis fibrosa cystica, one of them presented brown tumors. The highest preoperative calcemia was 15.28mg/dl. 3 patients were <50y, 6 patients had calcium 1mg/dl higher than the normal limit, 7 patients had osteoporosis and 7 patients had nephrolithiasis, so 9 patients met 1 surgical criterion, 3 met 2 criteria, and 3 met 3 criteria. 80% parathyroid adenoma, 6.67% atypical parathyroid adenoma, 6.67% parathyroid carcinoma and 6.67% nodular hyperplasia, were obtained. Postoperative calcemia was normalized in 100% of patients with >1 year follow-up (12 out of 15).
Conclusions:
Atypical adenoma and parathyroid carcinoma are relevant entities that can be found relatively frequently in cases of giant parathyroid adenoma, so it is important to register carefully the weight and size of the adenomas.