Parathyroid adenoma

Background: Primary hyperparathyroidism (PHPT) is a common clinical endocrine disorder. It is the most common
cause of hypercalcemia in the outpatient setting. This review presents a brief summary of the new trends of presentation,
diagnosis and management PHPT.
Data Sources: PubMed (National Library of Medicine) articles, and Memorial Library archives of the University of
Wisconsin System.
Conclusions: PHPT occurs at any age, but it is most commonly seen in people over the age of 50 years and
postmenopausal women. The current presentation of PHPT shifts from the classical symptomatic form to the
asymptomatic form; however, parathyroidectomy is still the treatment of choice for both symptomatic and asymptomatic
forms. In the past, bilateral neck exploration and intraoperative identification of all 4 parathyroid glands was the
standard of treatment, nevertheless, nowadays, with the introduction of the preoperative and intraoperative localization
techniques, the minimally invasive parathyroidectomy has evolved.

Background—Parathyroid cryopreservation is often utilized for patients having parathyroidectomy. This allows for future autotransplantation if a patient becomes permanently hypocalcemic after surgery. However, the practice of cryopreservation is costly and time consuming, while the success rate of delayed autotransplantation is highly variable. We sought to determine the rate and outcomes of parathyroid cryopreservation and delayed autotransplantation at our institution to further evaluate its utility.

We report a case of intrathymic parathyroid The most common cause of primary adenoma that was localized preoperatively by hyperparathyroidism is parathyroid adenoma. Up Technetium MIBI SPECT and treated surgically to 20% of parathyroid ademomas has been via assisted Thoracoscopic surgery and reported to be in ectopic localization. Ectopic developing hungry bone syndrome after surgery. p arathyroid glands can also become ( R a w a l M e d J 2 0 1 3 ; 3 8 : 3 1 4 - 3 1 6 ) . adenamatous, causing a diagnostic dilemma Key words: Primary hyperparathyroidism, when they are difficult to localize preoperatively. parathyroid adenoma, Intrathymic.

Introduction The clinical entity of large parathyroid adenomas (LPTAs) has not been well defined. It is speculated that LPTAs would have biochemical, histological, and molecular characteristics different from small adenomas. Our study aimed to find out occurrence of atypia and carcinomas in large parathyroid lesions and the presence of distinct molecular abnormalities in LPTAs. Materials and methods We divided the parathyroid lesions into large ([7 g, i.e., LPTAs) and small (\7 g) ade-nomas. We performed parafibromin, APC (adenomatous polyposis coli), galectin 3, and PGP9.5 (protein gene product 9.5) analysis by immunohistochemistry in adenomas without atypia, atypical adenomas, and carcinomas. Results Mean serum calcium, alkaline phosphatase, and intact PTH were significantly higher in large parathyroid tumor group. The presence of both atypical adenoma and carcinoma was higher in large parathyroid tumor group. There was higher percentage of atypia in patients with LPTAs[10 g (33 %), and 68 % of tumors showed at least one marker suggestive of malignancy in this group. Detailed analysis of immunohistochemical features of LPTA [10 g revealed that six patients showed complete loss of parafibromin immunoreactivity (out of these four showed atypia), while seven showed partial loss. In histopathologically proven malignancy (n = 9), six patients showed complete loss of parafi-bromin staining, 5 (55 %) APC negativity, and 45 % showed both galectin 3 and PGP9.5 positivity. Three out of these showed all IHC markers s/o malignancy, and all of them had evidence of metastases or recurrence. 32 % of atypical adenoma and 13 % of atypical adenoma showed complete loss of parafibromin staining, however none developed metastases or recurrence in follow-up (median follow-up 40 months). Loss of parafibromin staining (complete or partial) was higher in LPTA group (56 %) than that in small adenoma (39 %); however, it was not statistically significant. APC, galectin 3, and PGP9.5 markers suggestive were higher in LPTA group but were not significant. Conclusion LPTAs may show some morphological and immunohistochemical features suggestive of malignancy and can be considered a separate entity. However, the immunohistochemical markers are unable to clearly segregate those LPTAs that may show premalignant potential. Further, we would like to recommend that LPTAs showing complete parafibromin loss together with atypia should be kept under close follow-up.