Table 1 Literature review: Case studies of giant parathyroid adenoma (2009–2019)
From: Giant parathyroid adenoma: a case report and review of the literature
Study* | Sex | Age, years | Side | Presentation | Ca (mmol/L)/PTH (ng/L) | Radiology | Treatment | IPTH | Dimensions (mm) | Weight (g) | Pathology | Postoperative complicationsa |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
Thyroidal | ||||||||||||
Aggarwal et al., 2009 [11] India | F | 33 | L | Visible swelling, palpable nodule, bone pain, R humerus and R pelvic fractures | 2.65/762 | US: well-defined hypoechoic lesion, posterior to left lobe thyroid | Parathyroidectomy (not specified) | — | 95 × 50 × 35 | 102 | Chief cell adenoma | Symptomatic hypocalcemia |
Salehian et al., 2009 [12] Iran | F | 53 | R | Visible swelling, bone pain, nausea, vomiting, weight loss | 3.65/1624 | US neck: heteroechoic mass, inferior right lobe (2 × 4.8 × 3 cm); 99mTc-MIBI: abnormal collection of tracer in R side of neck | Neck exploration and parathyroidectomy (collar neck incision) | — | 55 × 35 × 20 | 30 | PTA | Nil |
Sisodiya et al., 2011 [13] India | F | 52 | R | Recurrent vomiting | 4.25/598 | US: large hypoechoic lesion in right paratracheal region with retrosternal extension | Parathyroidectomy, low anterior cervical approach | Mentioned in discussion | 39 × 20 × 17 | — | — | Hypocalcemia |
Asghar et al., 2012 [14] Pakistan | F | 55 | L | Parathyroid crisisb Palpable nodule | 5.75/1182 | US: large cyst (6 × 3.7 cm) on left side with thrombosis of IJV; MIBI: cystic lesion in left side neck displacing the thyroid gland on the right; CT: large hypodense lesion left side of neck with peripheral enhancement, retrosternal extension and mass effect with deviation of trachea and thrombosis of LIJV | Parathyroidectomy T-shaped incision 10 suspicious-looking lymph nodes also removed from levels 7 and 8 (by ENT and thoracic surgery teams) | — | 110 × 70 × 60 | — | PTA with prominent cystic degeneration; no lymph node metastasis | Nil |
Vilallonga et al., 2012 [10] Spain | F | 19 | L | Parathyroid crisis | 3.55/1207 | US: 47 × 22 mm nodule in left thyroid lobe | Hemithyroidectomy (it was intrathyroidal) | Available, not used | Max. diameter 30 | 70 | Intrathyroidal PTA | None Calcium IV d1, oral d2 |
Neagoe et al., 2014 [1] Romania (3 cases) | M/F/F | 57/60/33 | R/L/R | C 1: Bone pain, abdominal pain, nausea, palpable nodule C 2: Parathyroid crisis, palpable nodule C 3: Recurrent kidney stones, brown tumor of tibia | C 1: 3.54/1780 C 2: 4.04/863 C 3: 3.15/1174 | MIBI: detected adenomas in the 3 cases | Bilateral neck exploration and parathyroidectomy | Not feasiblec | C 1: 50 × 30 × 20 C 2: 55 × 40 × 30 — | C 1: 30.6 C 2: 35.2 C 3: > 30 | 2 PTA; 1 partially cystic PTA | C 1: Hungry bones syndrome C 2: Mild hypocalcemia and hungry bones syndrome C 3: Mild hypocalcemia |
Haldar et al., 2014 [15] UK | F | 61 | L | Asymptomatic | 3.17/179.2 | US: 6 cm mass in L inferior cervical location; MIBI: persistent activity in same location; SPECT: tubular structure in superior mediastinum | Parathyroidectomy (selective) 4 cm left collar neck incision | — | 65 × 30 × 15 | 12 | PTA | Nil |
Garas et al., 2015 [5] UK | F | 53 | L | Bone pain, palpable nodule | 3.98/4038 | US: lobular well-defined hypoechoic lesion behind L lower pole of thyroid gland; MRI: left inferior PTA, extends deep into mediastinum | Parathyroidectomy (transverse cervical incision) | Done – 94% reduction in 25 minutes | Max. diameter 70 | 27 | Chief cell PTA | Nil |
Rutledge et al., 2016 [7] Ireland | F | 21 | R | Enlarging neck mass, constipation, palpable nodule | 2.73/1305.1 | MIBI: lesion posterior to right lobe of thyroid with concentrated tracer | R thyroid lobectomy and parathyroidectomy with level 6 neck dissection (suspected carcinoma) | — | 80 × 55 × 30 | 58.8 | Atypical PTA | Symptomatic hypocalcemia, hungry bone syndrome |
Krishnamurthy et al., 2016 [16] India | M | 50 | L | Recurrent attacks of acute pancreatitis, palpable fullness | 2.77/669 | CT: 6 × 4 cm mass in L paratracheal region with extension to superior mediastinum; PET–CT: isolated uptake, left paratracheal region; MIBI: localized to L inferior parathyroid gland; Preoperative FNA-C was doned | Parathyroidectomy via transcervical approach | — | Max. diameter 60 | 20 | PTA | Hypocalcemia |
Castro et al., 2017 [17] Spain | F | 40 | L | Asymptomatic, palpable nodule | 3.35/825 | US: solid lesion behind L thyroid lobe; SPECT: intense uptake, back of L thyroid lobe in early and late phases | Parathyroidectomy (not specified) | Done, 90% reduction | 64 × 16 × 20 | 10.8 | PTA | Hypocalcemia |
Sahsamanis et al., 2017 [18] Greece | F | 42 | L | Abdominal pain | 2.60/151 | US: enlarged parathyroid gland on lower side of cervical region; MIBI: large concentrations of radiotracer in the same location | Minimally invasive parathyroidectomy | Not done | 33 × 20 × 14 | 5.39 | PTA | Nil |
Mantzoros et al., 2018 [19] Greece | F | 73 | R | Neck swelling, bone pain | 3.63/1629 | US: hypoechoic nodule at inferior pole of the right thyroid; MIBI: hyper functioning rightlower parathyroid gland | Minimally invasive parathyroidectomy | Done, 95% reduction 20 minutes after removal | 50 × 25 × 25 | 30 | PTA | Hungry bone syndrome |
Mediastinal | ||||||||||||
Migliore et al., 2013 [8] Italy | F | 65 | R | Persistent hypercalcemiae | Both elevated | CT: 7 cm mass in posterior mediastinum; MIBI: confirmed the CT finding | Video-assisted minithoracotomy | — | — | 95 | PTA | Nil |
Taghavi Kojidi et al., 2016 [20] Iran | M | 70 | Mid | Anorexia, nausea, bone pain, constipation, symptomatic kidney stones, polydipsia | 3.60/930 | US: multiple isoechoic nodules, no parathyroid glands seen; MIBI: focal radiotracer accumulation, midline anterior chest wall; CT: soft tissue density mass, mild enhancement, anterior midline, xiphoid level | Surgical removal (not specified) f | — | — | 75 | Active parathyroid lesion | Hypocalcemia |
Pecheva et al., 2016 [21] UK | F | 72 | R | Depression, severe osteoporosis (T = −3.2) | 3.02/250.8 | US: no parathyroid lesion; MIBI: no evidence of PTA; CT: complex cystic solid mass in the mediastinum | Parathyroidectomy via VATS | Not used, emergency | — | 19 | PTA | Hoarseness, bovine cough |
Talukder et al., 2017 [22] India | F | 49 | Mid | Brown tumor | 14.07/1000 | US: no abnormal parathyroid gland; MIBI: tracer-avid lesion in anterior mediastinum; PET-CT: ectopic parathyroid tissue in anterior mediastinum behind manubrium sterni | Parathyroidectomy via cervical collar incision and hemisternotomy | — | 40 × 30 × 20 | 12 | Neuroendocrine cell tumor | Nil |
Garuna Murthee et al., 2018 [9] UK | M | 72 | Mid | Anorexia, lethargy, abdominal cramps, constipation, weight loss | 15.19/1867.1 | CXR: sizeable mediastinal mass; CT: 9 cm solid cystic anterior mediastinal tumor; MIBI: heterogeneous tracer uptake in the mediastinal mass | Medial sternotomy and total thymectomy | — | Maximum diameter 78 | 220 | Intrathymic PTA | Nil |
Miller et al., 2019 [23] UK | M | 53 | Mid | Asymptomatic renal stones | 11.22/179.2 | MIBI: linear region of increased intensity in the left mediastinum | Parathyroidectomy via transcervical excision | Done, 81% reduction after 10 minutes | 80 × 30 × 30 | 30.9 | PTA | Nil |