Surgical treatment of double parathyroid adenomas in primary hyperparathyroidism: A clinical case
| Autor: | Gleb A. Bersenev, Elena A. Ilyicheva |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Adenoma endocrine system diseases Primary hyperparathyroidism Urology Parathyroid hormone Case Report Tumors of parathyroid glands Scintigraphy 03 medical and health sciences 0302 clinical medicine medicine Calcium metabolism Hyperparathyroidism Surgical treatment medicine.diagnostic_test business.industry Thyroid Ultrasound Double adenomas medicine.disease digestive system diseases stomatognathic diseases medicine.anatomical_structure 030220 oncology & carcinogenesis Hyperparathyroid gland disease Hypercalcemia 030211 gastroenterology & hepatology Surgery business hormones hormone substitutes and hormone antagonists |
| Zdroj: | International Journal of Surgery Case Reports |
| ISSN: | 2210-2612 |
| Popis: | Highlights • Double adenomas in primary hyperparathyroidism are a difficult diagnostic and therapeutic task. • A comprehensive and thorough assessment of all methods for visualization of the parathyroid glands at the preoperative stage. • Double adenomas require a bilateral neck audit with a visual assessment of all parathyroid glands. • A positive test during intraoperative monitoring of iPTH does not exclude a double adenoma in a patient. Introduction The frequency of occurrence of double parathyroid adenomas in patients with primary hyperparathyroidism is from 2 to 11% of cases. Nowadays, double adenomas remain a difficult diagnostic and therapeutic task. Presentation of case A 64-year-old woman was referred to an endocrine surgeon to evaluate a persistently elevating level of calcium. In the biochemical analysis the serum level of total calcium was increased - 2.79 mmol/l, ionized calcium - 1.64 mmol/l, parathyroid hormone - 191.4 pg/mL. Ultrasound and MSCT scan of the neck showed an increase of the parathyroid glands under the lower poles of both lobes of the thyroid gland. No functionally active parathyroid glands were found on scintigraphy. The patient underwent bilateral neck exploration with identification of all four parathyroid glands and a double parathyroid adenomectomy. According to a histological study, the removed parathyroid glands are represented by adenomas from the dark main cells. Remission of primary hyperparathyroidism was achieved. Discussion This clinical report confirms the literature on a decrease in the sensitivity of imaging methods in the diagnosis of double adenomas. A decrease in the effectiveness of intraoperative monitoring of parathyroid hormone with double adenomas was confirmed. In this patient, a double parathyroid adenomectomy was sufficient to achieve remission of hyperparathyroidism. Conclusion With double adenomas, a comprehensive assessment of all imaging methods is required. A positive test during intraoperative monitoring of IPTG does not exclude a double adenoma in a patient. It is necessary to perform a bilateral neck exploration with identification of all parathyroid glands. |
| Databáze: | OpenAIRE |
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