National Cancer Institute®
Last Modified: March 1, 2002
UI - 11845573
AU - Mannesse CK; van Ouwerkerk BM; Willemse AP
TI - [Cognitive deterioration in the elderly due to primary hyperparathyroidism--resolved by parathyroidectomy]
SO - Ned Tijdschr Geneeskd 2002 Jan 26;146(4):188
UI - 11848332
AU - Agrawal R; Agarwal A; Kar DK; Agarwal G; Jain M; Krishnani N; Gupta S;
TI - Mithal A; Mishra SK Parathyroid carcinoma.
SO - J Assoc Physicians India 2001 Oct;49():990-3
AD - Department of Endocrine Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
INTRODUCTION: Parathyroid carcinoma is a rare tumor with an incidence of 0.5 to 4%. Preoperative differentiation from benign adenoma is very difficult. Several features, though nonspecific, have been used in differentiating parathyroid carcinoma from the adenoma. MATERIAL AND METHOD: A retrospective analysis during the period of nine years, four cases of parathyroid carcinoma were diagnosed on the basis of per-operative local invasion and on histological evidence of capsular invasion and vascular invasion. RESULT: We have different observations to make. Diagnosis of parathyroid carcinoma which was done on the basis of intra operative suspicion only. One patient died on 6th post operative day due to development of pancreatitis. At the follow-up of two years there was no local recurrence or distant metastasis. CONCLUSION: It is preferable to have a high index of suspicion for parathyroid carcinoma when these features are present than to miss the opportunity for surgical cure by failing to consider it in the differential diagnosis.
UI - 11870248
AU - Broadus AE; Braaten KM
TI - Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 7-2002. A 47-year-old woman with late recurrent hyperparathyroidism.
SO - N Engl J Med 2002 Feb 28;346(9):694-700
AD - Division of Endocrinology and Metabolism, Yale University School of Medicine, New Haven, CT, USA.
UI - 11854692
AU - Civelek AC; Ozalp E; Donovan P; Udelsman R
TI - Prospective evaluation of delayed technetium-99m sestamibi SPECT scintigraphy for preoperative localization of primary hyperparathyroidism.
SO - Surgery 2002 Feb;131(2):149-57
AD - Russell H. Morgan Department of Radiology and Radiological Science, Division of Nuclear Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
BACKGROUND: Delayed technetium-99m sestamibi single photon emission computed tomography (SPECT) scans were prospectively analyzed in a large series of patients with primary hyperparathyroidism. METHODS: Three hundred thirty-eight patients underwent sestamibi-SPECT and were explored. Prospective data included preoperative demographics, clinical, sestamibi, and operative findings, laboratory values, and pathologic and follow-up laboratory results from all patients. RESULTS: Between 1994 and 2000, 287 unexplored patients (85%) and 51 re-explored patients (15%) participated. The abnormal parathyroid glands excised from 336 of 338 patients included 299 single adenomas (88%) and 23 double adenomas (7%), and 14 patients had multigland hyperplasia (4%). Sestamibi SPECT correctly lateralized 349 of 400 abnormal parathyroid glands, with an overall sensitivity of 87%, an accuracy of 94%, and a positive predictive value of 86%. Precise localization occurred in 82% of the abnormal parathyroid glands. Sestamibi sensitivity was similar in unexplored (87%) and reoperative (92%) cases; two hundred eighty-six of 299 (96%) solitary adenomas, 38 of 46 (83%) double adenomas, but only 25 of 55 (45%) hyperplastic glands were identified. The mean weight of the true-positive glands (1252 +/- 1980 mg) was greater than that of the false-negative glands (297 +/- 286 mg) (P <.005). Three patients had persistent primary hyperparathyroidism, in spite of the excision of sestamibi-identified lesions in 2 cases. Follow-up indicated curative resection in 99% of the unexplored cases and 94% of the remedial cases. CONCLUSIONS: Sestamibi SPECT is highly accurate for the localization of parathyroid adenomas in unexplored and re-explored cases, where it is often the only imaging required. Its sensitivity is limited in multiglandular disease.
UI - 11819104
AU - Cupisti K; Dotzenrath C; Simon D; Roher HD; Goretzki PE
TI - Therapy of suspected intrathoracic parathyroid adenomas. Experiences using open transthoracic approach and video-assisted thoracoscopic surgery.
SO - Langenbecks Arch Surg 2002 Jan;386(7):488-93
AD - Klinik fur Allgemein- und Unfallchirurgie, Universitatsklinikum, Heinrich-Heine-Universitat Dusseldorf, Moorenstrasse 5, 40225 Dusseldorf, Germany. email@example.com
BACKGROUND AND AIMS: Ectopic mediastinal parathyroid adenoma as a cause of primary hyperparathyroidism (pHPT) can normally be resected from conventional collar incision. In rare cases with adenomas deeper in the chest, a transthoracic approach is necessary. PATIENTS/METHODS: We report our experience of 19 patients with suspected mediastinal parathyroid adenomas from a total of 1035 patients with pHPT who were operated on between 1986 and 2000 using an open approach (sternotomy or thoracotomy) or video-assisted mediastinal or thoracoscopic surgery (VAMS/VATS). RESULTS: Fourteen patients underwent an open approach with a success rate of 71% (10 of 14). Four patients remained hypercalcaemic. There were four complications in three patients: three permanent recurrent nerve palsies and one chylus fistula, requiring further surgery. VATS was successful in three of four patients with conversion to sternal splitting because of a false-negative frozen section in one patient. Another patient had parathyroid adenoma retrosternally which could not be resected by means of VAMS and had to be excised using a transsternal approach. There were no complications of minimal invasive procedures. All five patients were normocalcaemic after the operation. CONCLUSION: Ectopic parathyroid adenomas not resectable by means of a collar incision are rare causes of pHPT and comprise 1.25% of all patients with pHPT in our series. For these patients, VATS revealed an alternative to conventional open procedures. In questionable cases, however, the collar incision should precede the VATS procedure.
UI - 11822866
AU - Yoshida T; Nagahama T; Maruyama M; Ebuchi M
TI - Thoracoscopically managed parathyroid adenoma in the upper anterior mediastinum.
SO - Surg Laparosc Endosc Percutan Tech 2001 Dec;11(6):385-8
AD - Department of Surgery, Tokyo Metropolitan Ohkubo Hospital, Japan. firstname.lastname@example.org
We thoracoscopically managed parathyroid adenoma of the upper anterior mediastinum in a 29-year-old man. He had a backache and was found to have bilateral ureteric stones, hypercalcemia, and extremely increased parathyroid hormone levels. 99mTc-methoxyisobutyl isonitrile scintigraphy showed an accumulation area projected onto the right thyroid lobe and the upper mediastinum. A diagnosis of primary hyperparathyroidism secondary to double adenomas was made. The patient then underwent surgical intervention. With the patient under general anesthesia with one-lung ventilation, a reddish brown adenoma of an upper mediastinum was removed thoracoscopically with three trocars, whereas the right superior parathyroid adenoma was excised by a standard open cervical procedure. Conventionally, the mediastinal parathyroid adenoma was removed by an open approach and was associated with perioperative distress to the patient. If the exact location of the mediastinal lesion is established, thoracoscopic excision of these lesions is feasible and is strongly recommended.
UI - 11740057
AU - Kar DK; Agarwal G; Mehta B; Agarwal J; Gupta RK; Dhole TN; Mishra SK
TI - Tuberculous granulomatous inflammation associated with adenoma of parathyroid gland manifesting as primary hyperparathyroidism.
SO - Endocr Pathol 2001 Fall;12(3):355-9
AD - Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
A 36-year-old female presented with generalized bone pain, muscular weakness and enlarged cervical lymph nodes. The biochemical findings and skeletal survey was suggestive of primary hyperparathyroidism (PHPT). CT of neck and thorax showed enlarged multiple lymph nodes in the cervical and superior mediastinal region. With a diagnosis of PHPT she underwent cervical exploration and excision of enlarged right inferior parathyroid gland along with biopsy of nodes were done. Histopathology revealed the features of right parathyroid adenoma with few foci of epithelioid granuloma and granulomatous lymphadenitis. AFB smear and culture sensitivity was negative. A positive PCR for Mycobacterium tuberculosis of the homogenates of parathyroid tumor confirmed tuberculous inflammation within the parathyroid adenoma. To the best of our knowledge this is the first reported case of parathyroid adenoma associated with tuberculous pathology in a case of PHPT.
UI - 11834430
AU - Garcia JL; Tardio JC; Gutierrez NC; Gonzalez MB; Polo JR; Hernandez JM;
TI - Menarguez J Chromosomal imbalances identified by comparative genomic hybridization in sporadic parathyroid adenomas.
SO - Eur J Endocrinol 2002 Feb;146(2):209-13
AD - Centro de Investigacion del Cancer, Universidad de Salamanca-CSIC, Salamanca, Spain.
OBJECTIVE: To identify chromosomal gains and losses in sporadic parathyroid adenomas (PAs). METHODS: Fourteen sporadic PAs were studied by comparative genomic hybridization (CGH). RESULTS: The fourteen studied PAs showed chromosomal imbalances. All cases except one exhibited two or more abnormalities. Chromosomal gains were found in all cases, and three cases (21%) also presented chromosomal losses. Genomic amplification was not observed. Chromosome 9 was involved in ten cases. Recurrent genetic gain was found on 9p22-24 and on 9q34, each in 6 of 14 cases (43%). Other recurrent gains included Xq26 in 6 PAs (43%) and 4q21-28 and 8p22-23, each in 4 of 14 cases (29%). Regions of recurrent genetic loss involved whole chromosome 11 and 20q12-13, each in 2 of 14 cases (14%). CONCLUSIONS: Our findings show chromosomal imbalances in all sporadic PAs studied by CGH, partly confirming previous reports, with the exception that we observed more chromosomal gains than losses. Several regions (9p22-24, 9q34, Xq26, 4q21-28, and 8p22-23) probably deserve further investigation in order to discard the presence of genes involved in parathyroid tumorigenesis.
UI - 11874419
AU - Villablanca A; Farnebo F; Teh BT; Farnebo LO; Hoog A; Larsson C
TI - Genetic and clinical characterization of sporadic cystic parathyroid tumours.
SO - Clin Endocrinol (Oxf) 2002 Feb;56(2):261-9
AD - Department of Molecular Medicine, Karolinska Hospital, Stockholm, Sweden. email@example.com
OBJECTIVE: The hyperparathyroidism--jaw tumour (HPT--JT) syndrome is one of the familial disorders characterized by primary hyperparathyroidism and has been linked to the chromosomal region of 1q32--q21. The parathyroid tumours related to this syndrome have shown loss of wild-type alleles at this locus suggesting that inactivation of a tumour suppressor gene might be responsible for the disease. In the majority of these tumours cysts are a prominent feature. By loss of heterozygosity (LOH) studies, we investigated the region of interest in an attempt to clarify its possible role in a series of cystic sporadic parathyroid adenomas. DESIGN AND SUBJECTS: A total of 30 patients diagnosed with sporadic hyperparathyroidism were included in the study, genotyped with 17 polymorphic microsatellite markers at chromosome 1q, and additional markers from 1p and 11q13 which are commonly involved in sporadic parathyroid tumours. The cystic parathyroid tumours were characterized clinically, and immunohistochemistry against PTH was carried out to confirm the parathyroid origin of the cysts. RESULTS: LOH was found in six of 30 tumours (20%) on 1q, six of 30 tumours (20%) on 1p and five of 30 tumours (17%) on 11q13. We found a significant correlation between allelic alterations and the clinical parameters, tumour weight and PTH. Furthermore, we found a significant difference between tumour weight and PTH in cases of cystic parathyroid tumours compared with unselected sporadic cases. CONCLUSIONS: These results suggest that cystic parathyroid tumours might represent a new subgroup among parathyroid tumours based on the genetic and clinical findings. Loss of heterozygosity at 1q further supports the presence of a tumour suppressor gene at this locus.
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