Primary hyperparathyroidism caused by giant parathyroid adenoma

Selective surgical approach

  • Daniel González González Universidad de la República, Facultad de Medicina, Clínica Quirúrgica 3, Prof. Titular
  • Cecilia Chambón Universidad de la República, Facultad de Medicina, Clínica Quirúrgica 3, Asistente
  • Gustavo Armand Ugón Universidad de la República, Facultad de Medicina, Clínica Quirúrgica 3, Prof. Adjunto
DOI: https://doi.org/10.29193/RMU.37.1.13
Keywords: PRIMARY HYPERPARATHYROIDISM, PARATHYROID NEOPLASMS, GIANT PARATHYROID ADENOMA, PARATHYROIDECTOMY

Abstract

Introduction: primary hyperparathyroidism caused by giant parathyroid adenoma is a rather unusual condition. Reported large adenomas occurred in ectopic parathyroid glands (mediastinal). Just like carcinomas, they are large, present high calcemia and parathyroid hormone values, what complicates diagnosis. Surgical treatment consists in parathyroidectomy by means of transversal cervicotomy around the infrahyoid region.
Objective: the study presents the clinical case of primary hyperparathyroidism caused by giant parathyroid adenoma that was treated by selective surgery approach.
Clinical case: 53 year-old female patient with a history of uretheral lithiasis, bone pain and 4-cm-diameter infrahyoid tumor. Imagenology studies revealed the characteristics of lower left parathyroid adenoma. Functional assessment confirmed hyperparathyroidism.
Upon the diagnosis of primary hyperparathyroidism caused by giant parathyroid adenoma it was surgically addressed by means of a small cut around the tumour and performing a lower left parathyroidectomy, what resulted in the remission of symptoms and normalized parathyroid functionality.
Discussion: primary hyperparathyroidism caused by giant parathyroid adenoma has an indication for surgery and is therapeutic. The case presented shows the feasibility and safety of a selective approach, as well as its smaller cosmetic harm, managing to keep the contralateral thyroid loggia intact, in view of future surgeries involving it.

References

1) Spanheimer PM, Stoltze AJ, Howe JR, Sugg SL, Lal G, Weigel RJ. Do giant parathyroid adenomas represent a distinct clinical entity? Surgery 2013; 154(4):714-8.
2) Garuna Murthee K, Tay WL, Soo KL, Swee DS. A migratory mishap: giant mediastinal parathyroid adenoma. Am J Med 2018; 131(5):512-6.
3) Cakmak H, Tokat AO, Karasu S, Özkan M. Giant mediastinal parathyroid adenoma. Tuberk Toraks 2011; 59(3):263-5.
4) Lalanne-Mistrih ML, Ognois-Ausse P, Goudet P, Cougard P. Giant parathyroid tumors: characterization of 26 glands weighing more than 3.5 grams. Ann Chir 2002; 127(3):198-202.
5) Sulaiman L, Nilsson IL, Juhlin CC, Haglund F, Höög A, Larsson C, et al. Genetic characterization of large parathyroid adenomas. Endocr Relat Cancer 2012; 19(3):389-407.
6) Power C, Kavanagh D, Hill AD, O’Higgins N, McDermott E. Unusual presentation of a giant parathyroid adenoma: report of a case. Surg Today 2005; 35(3):235-7.
7) Maciá C, Ronzón A, Botas P, Castaño G. Hipercalcemia y disfonía por adenoma gigante de paratiroides. Endocrinol Nutr 2005; 52(4):189-90.
8) Garas G, Poulasouchidou M, Dimoulas A, Hytiroglou P, Kita M, Zacharakis E. Radiological considerations and surgical planning in the treatment of giant parathyroid adenomas. Ann R Coll Surg Engl 2015; 97(4):e64-6.
9) Neagoe RM, Sala DT, Borda A, Mogoantă CA, Műhlfay G. Clinicopathologic and therapeutic aspects of giant parathyroid adenomas - three case reports and short review of the literature. Rom J Morphol Embryol 2014; 55(2 Suppl):669-74.
10) Araujo Castro M, Abad López A, Martín Fragueiro L, Palacios García N. Giant parathyroid adenoma: differential aspects compared to parathyroid carcinoma. Endoc Diab Metab Case Rep 2017;pii17-0041.
11) Aygün N, Uludag M. Surgical treatment of primary hyperparathyroidism: which therapy to whom?. Sisli Eftal Hastan Tip Bul 2019; 53(3):201-4.
12) Al-Hassan MS, Mekhaimar M, El Ansari W, Darweesh A, Abdelaal A. Giant parathyroid adenoma: a case report and review of the literature. J Med Case Rep 2019; 13(1):332.
13) Mantzoros I, Kyriakidou D, Galanos-Demiris K, Chatzakis C, Parpoudi S, Sapidis N, et al. A rare case of primary hyperparathyroidism caused by a giant solitary parathyroid adenoma. Am J Case Rep 2018; 19:1334-7.
14) Haldar A, Thapar A, Khan S, Jenkins S. Day-case minimally invasive excision of a giant mediastinal parathyroid adenoma. Ann R Coll Surg Engl 2014; 96(5):e21-3.
15) Meyer-Rochow GY, Sidhu SB, Delbridge LW, Grodski S, Sywak MS. Can giant parathyroid adenomas be safely removed by minimally invasive parathyroidectomy. ANZ J Surg 2007; 77(Suppl 1):A23.
16) Christakis I, Michas S, Mouziouras V, Augoustis C, Dimas S. Minimally invasive techniques for giant parathyroid tumours; An oxymoron?. Hellenic J Surg 2012; 84(4):220-4.
17) Sahsamanis G, Gkouzis K, Samaras S, Pinialidis D, Dimitrakopoulos G. Surgical management of a giant parathyroid adenoma through minimal invasive parathyroidectomy. A case report. Int J Surg Case Rep 2017; 31:262-5.
Published
2021-03-31
How to Cite
1.
González González D, Chambón C, Armand Ugón G. Primary hyperparathyroidism caused by giant parathyroid adenoma. Rev. Méd. Urug. [Internet]. 2021Mar.31 [cited 2024Dec.26];37(1):e37114. Available from: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/684
Issue
Vol 37 No 1 (2021): Revista Médica del Uruguay
Section
Clinical Cases
Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.