Double Adenoma As A Cause Of Primary Hyperparathyroidism

Double Adenoma As A Cause Of Primary Hyperparathyroidism

Asymmetric Hyperplasia Or A Distinct Pathologic Entity?

[Posted 9/Sep/2021]

AUDIENCE: General Surgery, Family Medicine

KEY FINDINGS: Most patients with DA are cured with removal of two glands, but approximately 5% experience disease persistence/recurrence. Low-normal final IOPTH was associated with lower risk of persistent/recurrent disease.

BACKGROUND: Primary hyperparathyroidism (PHPT) caused by double adenoma may carry a higher risk of failure to cure. We compared outcomes in single adenoma (SA), double adenoma (DA) and four-gland hyperplasia (HP).

DETAILS: Patients undergoing initial parathyroidectomy for PHPT were categorized by diagnosis. The primary outcome was persistent/recurrent disease postoperatively. Of 3408 patients, 81.3% had SA, 9.5% had DA, and 9.3% had HP. Rates of persistence/recurrence were 2.9%, 5.3%, and 4.5% in SA, DA, and HP, respectively (p = 0.281). Patients with persistence/recurrence had higher preoperative calcium (11.0 vs 10.7 mg/dl, p = 0.028) and PTH (96 vs 77 pg/ml, p = 0.015), and lower rates of IOPTH normalization (77% vs 96%, p < 0.001). On multivariable analysis, DA was associated with increased risk of persistent/recurrent disease (OR 3.0, p = 0.017).

Copyright © 2021 Elsevier Inc. All rights reserved.

Source: Goodsell, K. E., Ermer, J. P., Zaheer, S., et al. (2021). Double adenoma as a cause of primary hyperparathyroidism: Asymmetric hyperplasia or a distinct pathologic entity?. Am J Surg. 2021; 222(3): 483-489. Published: September, 2021. DOI: 10.1016/j.amjsurg.2021.01.021.