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Multiglandular Parathyroid Disease
Grzegorz Kowalski1, Grzegorz Buła1, Adam Bednarczyk1
1Department of General and Endocrine Surgery, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland.
Introduction:
Multiglandular parathyroid disease (MGD) is an uncommon cause of primary hyperparathyroidism (pHPT) and has been reported in the literature in 8-33% of patients with pHPT. The aim of our study was to review the clinical characteristics and management of MGD and evaluation of surgical treatment failures.
Methods:
We performed a retrospective study of 163 patients with pHPT undergoing parathyroidectomy (PTX) at the Department of General and Endocrine Surgery between 1983 and 2018. All these patients were diagnosed with MGD. This group of patients was compared with a group of 856 patients with solitary disease operated for pHPT in the same period.
Results:
Among 163 patients-127 (79%) of them had two lesions, 28 (16%) had three, and 8 (5%) four. They were prevalently women over the age of 50. The diagnosis was based on PTH and ionized calcium studies and used sestamibi technetium-99m scintigraphy (MIBI) as well for us. Treatment was surgical.
Conclusions:
Parathyroidectomy (PTX) for multiglandular parathyroid disease (MGD) is associated with a higher operative risk of failure compared to solitary disease. Preoperative diagnosis and localization of the parathyroid glands is an extremely important element of treatment. Diagnosis is based on PTH and calcium levels. Ultrasonography (USG), MRI, and scintigraphy are very helpful in diagnosis. Mediastinal multiglandular parathyroid disease (MGD) is associated with increased surgical treatment failures. The treatment is surgical and consists of the removal of the masses or complete parathyroidectomy. Based on this study, we support the existence of multiple adenomas and advocate the removal of only macroscopically enlarged parathyroid glands in patients with primary hyperparathyroidism.
Insights
Multiglandular parathyroid disease (MGD) presents a higher risk of surgical failure in primary hyperparathyroidism (pHPT) compared to solitary disease. Accurate preoperative diagnosis and gland localization are crucial for successful parathyroidectomy (PTX).
Area of Science:
- Endocrine Surgery
- Surgical Pathology
- Oncology
Background:
- Multiglandular parathyroid disease (MGD) is an uncommon cause of primary hyperparathyroidism (pHPT), affecting 8-33% of patients.
- This study reviews clinical characteristics, management, and surgical outcomes of MGD.
Purpose of the Study:
- To evaluate the clinical features and surgical treatment outcomes of MGD.
- To compare MGD outcomes with solitary parathyroid disease.
Main Methods:
- Retrospective study of 163 MGD patients undergoing parathyroidectomy (PTX) between 1983-2018.
- Comparison with 856 patients with solitary parathyroid disease operated during the same period.
- Diagnosis based on PTH, ionized calcium, and sestamibi technetium-99m scintigraphy (MIBI).
Main Results:
- MGD patients were predominantly women over 50.
- 79% had two lesions, 16% had three, and 5% had four.
- Parathyroidectomy (PTX) for MGD showed a higher failure rate than for solitary disease.
Conclusions:
- MGD is associated with increased operative failure risk compared to solitary disease.
- Preoperative diagnosis and localization are critical for successful PTX.
- Support for removing only macroscopically enlarged glands in MGD patients.
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