Pre-operative differentiation of atypical parathyroid tumors and parathyroid adenomas: Is it possible?

This study aimed to determine whether atypical parathyroid tumors (APTs) can be differentiated from benign parathyroid adenomas (PAs) preoperatively and to compare their biochemical characteristics, post-operative complications, and long-term outcomes.

A retrospective analysis was conducted on patients who underwent parathyroidectomy between 2010 and 2022. Fifty patients with APT and one hundred with PA (control group) were included. Demographic data, biochemical parameters, complications, and follow-up outcomes were compared.

Pre--operative serum calcium and parathyroid hormone (PTH) levels were significantly higher in APT patients. Receiver operating characteristic analysis identified Ca > 11.5 mg/dL and PTH > 180 pg/mL as thresholds for distinguishing APTs. Multivariate analysis confirmed these as independent predictors. APT patients had a higher rate of concurrent thyroid surgery and more frequent complications such as transient nerve injury and hungry bone syndrome. No significant difference was found in persistent disease or recurrence after an average follow-up of 4.8 years.

Pre-operative Ca and PTH levels may help distinguish APTs from PAs. Patients with APT should be informed about the increased risk of complications and concurrent thyroid surgery, and appropriate preventive strategies should be considered.