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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*SexAge, yearsSidePresentationCa (mmol/L)/PTH (ng/L)RadiologyTreatmentIPTHDimensions (mm)Weight (g)PathologyPostoperative complicationsa
Thyroidal
 Aggarwal et al., 2009 [11]
India
F33LVisible swelling, palpable nodule, bone pain, R humerus and R pelvic fractures2.65/762US: well-defined hypoechoic lesion, posterior to left lobe thyroidParathyroidectomy (not specified)95 × 50 × 35102Chief cell adenomaSymptomatic hypocalcemia
 Salehian et al., 2009 [12]
Iran
F53RVisible swelling, bone pain, nausea, vomiting, weight loss3.65/1624US neck: heteroechoic mass, inferior right lobe (2 × 4.8 × 3 cm); 99mTc-MIBI: abnormal collection of tracer in R side of neckNeck exploration and parathyroidectomy (collar neck incision) —55 × 35 × 2030PTANil
 Sisodiya et al., 2011 [13]
India
F52RRecurrent vomiting4.25/598US: large hypoechoic lesion in right paratracheal region with retrosternal extensionParathyroidectomy,
low anterior cervical approach
Mentioned in discussion39 × 20 × 17 — —Hypocalcemia
 Asghar et al., 2012 [14]
Pakistan
F55LParathyroid crisisb
Palpable nodule
5.75/1182US: 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 LIJVParathyroidectomy 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 metastasisNil
 Vilallonga et al., 2012 [10]
Spain
F19LParathyroid crisis3.55/1207US: 47 × 22 mm nodule in left thyroid lobeHemithyroidectomy (it was intrathyroidal)Available, not usedMax. diameter 3070Intrathyroidal PTANone
Calcium IV d1, oral d2
 Neagoe et al., 2014 [1]
Romania
(3 cases)
M/F/F57/60/33R/L/RC 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 casesBilateral neck exploration and parathyroidectomyNot feasiblecC 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 PTAC 1: Hungry bones syndrome
C 2: Mild hypocalcemia and hungry bones syndrome
C 3: Mild hypocalcemia
 Haldar et al., 2014 [15]
UK
F61LAsymptomatic3.17/179.2US: 6 cm mass in L inferior cervical location; MIBI: persistent activity in same location; SPECT: tubular structure in superior mediastinumParathyroidectomy (selective)
4 cm left collar neck incision
 —65 × 30 × 1512PTANil
 Garas et al., 2015 [5]
UK
F53LBone pain, palpable nodule3.98/4038US: lobular well-defined hypoechoic lesion behind L lower pole of thyroid gland; MRI: left inferior PTA, extends deep into mediastinumParathyroidectomy (transverse cervical incision)Done – 94% reduction in 25 minutesMax. diameter 7027Chief cell PTANil
 Rutledge et al., 2016 [7]
Ireland
F21REnlarging neck mass, constipation, palpable nodule2.73/1305.1MIBI: lesion posterior to right lobe of thyroid with concentrated tracerR thyroid lobectomy and parathyroidectomy with level 6 neck dissection (suspected carcinoma) —80 × 55 × 3058.8Atypical PTASymptomatic hypocalcemia, hungry bone syndrome
 Krishnamurthy et al., 2016 [16]
India
M50LRecurrent attacks of acute pancreatitis, palpable fullness2.77/669CT: 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 donedParathyroidectomy via transcervical approach —Max. diameter 6020PTAHypocalcemia
 Castro et al., 2017 [17]
Spain
F40LAsymptomatic, palpable nodule3.35/825US: solid lesion behind L thyroid lobe; SPECT: intense uptake, back of L thyroid lobe in early and late phasesParathyroidectomy (not specified)Done, 90% reduction64 × 16 × 2010.8PTAHypocalcemia
 Sahsamanis et al., 2017 [18]
Greece
F42LAbdominal pain2.60/151US: enlarged parathyroid gland on lower side of cervical region; MIBI: large concentrations of radiotracer in the same locationMinimally invasive parathyroidectomyNot done33 × 20 × 145.39PTANil
 Mantzoros et al., 2018 [19]
Greece
F73RNeck swelling, bone pain3.63/1629US: hypoechoic nodule at inferior pole of the right thyroid; MIBI: hyper functioning rightlower parathyroid glandMinimally invasive parathyroidectomyDone, 95% reduction 20 minutes after removal50 × 25 × 2530PTAHungry bone syndrome
Mediastinal
 Migliore et al., 2013 [8]
Italy
F65RPersistent hypercalcemiaeBoth elevatedCT: 7 cm mass in posterior mediastinum; MIBI: confirmed the CT findingVideo-assisted minithoracotomy — —95PTANil
 Taghavi Kojidi et al., 2016 [20]
Iran
M70MidAnorexia, nausea, bone pain, constipation, symptomatic kidney stones, polydipsia3.60/930US: 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 levelSurgical removal (not specified) f — —75Active parathyroid lesionHypocalcemia
 Pecheva et al., 2016 [21]
UK
F72RDepression, severe osteoporosis (T = −3.2)3.02/250.8US: no parathyroid lesion; MIBI: no evidence of PTA; CT: complex cystic solid mass in the mediastinumParathyroidectomy via VATSNot used, emergency —19PTAHoarseness, bovine cough
 Talukder et al., 2017 [22]
India
F49MidBrown tumor14.07/1000US: no abnormal parathyroid gland; MIBI: tracer-avid lesion in anterior mediastinum; PET-CT: ectopic parathyroid tissue in anterior mediastinum behind manubrium sterniParathyroidectomy via cervical collar incision and hemisternotomy —40 × 30 × 2012Neuroendocrine cell tumorNil
 Garuna Murthee et al., 2018 [9]
UK
M72MidAnorexia, lethargy, abdominal cramps, constipation, weight loss15.19/1867.1CXR: sizeable mediastinal mass; CT: 9 cm solid cystic anterior mediastinal tumor; MIBI: heterogeneous tracer uptake in the mediastinal massMedial sternotomy and total thymectomy —Maximum diameter 78220Intrathymic PTANil
 Miller et al., 2019 [23]
UK
M53MidAsymptomatic renal stones11.22/179.2MIBI: linear region of increased intensity in the left mediastinumParathyroidectomy via transcervical excisionDone, 81% reduction after 10 minutes80 × 30 × 3030.9PTANil
  1. — not reported, cannot be inferred, C1 Case 1, C2 Case 2, C3 Case 3, CT computed tomography, CXR chest X-ray, ENT otolaryngology, F female, FNA-C fine-needle aspiration cytology, IPTH intraoperative parathyroid hormone, IJV internal jugular vein, L left, M male, Mid midline, MIBI Tc99m-sestamibi scintigraphy scan, PET positron emission tomography, PTA parathyroid adenoma, PTH fine-needle aspiration cytology, R right, SPECT single photon emission computed tomography, US ultrasound, VATS video-assisted thoracoscopic surgery
  2. * Due to space limitations, only the first author is mentioned
  3. a All of the cases had asymptomatic patients with normalized Ca and fine-needle aspiration cytology on follow up (except Haldar + Sisodya – Ca only)
  4. b Parathyroid crisis comprises anorexia, urinary frequency, severe nausea, vomiting, constipation
  5. c Done 1 hour postoperative for 2 cases, found to be normal
  6. d Preoperative fine-needle aspiration cytology showed a benign epithelial lesion that could not be further characterized
  7. e Patient had previous total thyroidectomy for goiter associated with hypercalcemic syndrome (exploration had showed four normal parathyroid glands)
  8. f Patient had previous total parathyroidectomy, thymectomy, and right hemithyroidectomy