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Primary hyperparathyroidism associated with two enlarged parathyroid glands.
D F Roses1, N S Karp, L A Sudarsky
1Department of Surgery, New York University Medical Center, NY 10016.
Archives of Surgery (Chicago, Ill. : 1960)
|November 1, 1989
Summary
Primary hyperparathyroidism can involve two enlarged parathyroid glands. Recognizing and removing both glands, even if asymmetric, is crucial for successful treatment and preventing recurrence.
Area of Science:
- Endocrinology
- Surgical Pathology
Background:
- A small subset of primary hyperparathyroidism cases present with enlargement of two parathyroid glands.
- This presentation can lead to diagnostic challenges and treatment failures if not fully addressed.
Observation:
- This study reviewed nine patients with primary hyperparathyroidism and double parathyroid gland enlargement.
- Four patients exhibited marked asymmetry between the two enlarged glands, leading to persistent or recurrent hyperparathyroidism if the second gland was missed.
- One patient had a supernumerary mediastinal gland as the second enlarged gland.
Findings:
- Complete excision of both enlarged parathyroid glands resulted in normocalcemia and prevented recurrence in all nine patients.
- Histological examination revealed true double adenomas in only three patients; the rest showed multiglandular hypercellularity.
- Failure to identify and excise the second enlarged gland, especially when asymmetric or mediastinal, resulted in treatment failure.
Implications:
- Thorough exploration and identification of all parathyroid glands are essential in managing primary hyperparathyroidism.
- Even minimally enlarged glands warrant consideration, irrespective of their histopathologic classification.
- Surgical excision of both enlarged glands, regardless of asymmetry or location, is the appropriate management strategy for double gland enlargement in primary hyperparathyroidism.