BACKGROUND: A double adenoma (DA) is a recognized clinical entity of primary hyperparathyroidism (HPT) and is presumed to have uniform location distribution. We reviewed our experience with 2-gland parathyroid disease to identify anatomic patterns and implications for surgical management. METHODS: Clinical characteristics were reviewed for 828 consecutive patients with HPT at 2 endocrine referral centers that practice bilateral neck exploration with intraoperative parathyroid hormone (IOPTH) measurement. RESULTS: Fifteen percent (127 of 828) of HPT patients demonstrated 2 enlarged glands; 13% (107 of 828), 3- or 4-gland hyperplasia; and 71% (592 of 828), single adenomas. DAs in superior parathyroids affected 57 of 127 (45%) patients, an observed frequency 3-fold higher than expected (P<.001, chi-square test). DAs were larger than normal glands (240+/-575 mg vs 28+/-23 mg, P<.001), and superior parathyroid adenomas were larger than adenomas at other sites (421+/-983 mg vs 202+/-353 mg, P=.002). Technetium 99 metastable (Tc99m)-sestamibi imaging and IOPTH identified DAs correctly in only 5 of 84 (6%) and 19 of 75 (25%) of patients tested, respectively. CONCLUSIONS: DAs have nonuniform anatomic distribution with predilection for abnormal growth in bilateral superior parathyroids-embryologic remnants of the fourth branchial pouch. Since additional abnormal glands were detected by observation with technetium 99 metastable (Tc99m)-sestamibi imaging and IOPTH rarely aiding detection, unilateral neck exploration may predispose to persistent or recurrent HPT.
BACKGROUND: A double adenoma (DA) is a recognized clinical entity of primary hyperparathyroidism (HPT) and is presumed to have uniform location distribution. We reviewed our experience with 2-gland parathyroid disease to identify anatomic patterns and implications for surgical management. METHODS: Clinical characteristics were reviewed for 828 consecutive patients with HPT at 2 endocrine referral centers that practice bilateral neck exploration with intraoperative parathyroid hormone (IOPTH) measurement. RESULTS: Fifteen percent (127 of 828) of HPT patients demonstrated 2 enlarged glands; 13% (107 of 828), 3- or 4-gland hyperplasia; and 71% (592 of 828), single adenomas. DAs in superior parathyroids affected 57 of 127 (45%) patients, an observed frequency 3-fold higher than expected (P<.001, chi-square test). DAs were larger than normal glands (240+/-575 mg vs 28+/-23 mg, P<.001), and superior parathyroid adenomas were larger than adenomas at other sites (421+/-983 mg vs 202+/-353 mg, P=.002). Technetium 99 metastable (Tc99m)-sestamibi imaging and IOPTH identified DAs correctly in only 5 of 84 (6%) and 19 of 75 (25%) of patients tested, respectively. CONCLUSIONS:DAs have nonuniform anatomic distribution with predilection for abnormal growth in bilateral superior parathyroids-embryologic remnants of the fourth branchial pouch. Since additional abnormal glands were detected by observation with technetium 99 metastable (Tc99m)-sestamibi imaging and IOPTH rarely aiding detection, unilateral neck exploration may predispose to persistent or recurrent HPT.
Authors: David Velázquez-Fernández; Cecilia Laurell; Milena Saqui-Salces; Juan Pablo Pantoja; Fernando Candanedo-Gonzalez; Alfredo Reza-Albarrán; Armando Gamboa-Dominguez; Miguel F Herrera Journal: World J Surg Date: 2006-05 Impact factor: 3.352
Authors: Kelly L McCoy; Naomi H Chen; Michaele J Armstrong; Gina M Howell; Michael T Stang; Linwah Yip; Sally E Carty Journal: World J Surg Date: 2014-06 Impact factor: 3.352
Authors: Linwah Yip; Daniel A Pryma; John H Yim; Mohamed A Virji; Sally E Carty; Jennifer B Ogilvie Journal: World J Surg Date: 2008-05 Impact factor: 3.352
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