STUDY OF CLINICAL FEATURES, SURGICAL MANAGEMENT AND OUTCOMES OF PARATHYROID ADENOMA

Abstract

Introduction: Parathyroid adenoma is a benign tumor of the parathyroid gland. It is the common cause of Primary hyperparathyroidism (pHPT). Parathyroidectomy is the curative treatment for Parathyroid adenoma.

Objectives: The objective was to study the clinical features, surgical management and outcomes of parathyroid adenoma

Materials and Methods: This was a retrospective study, included patients who underwent surgery for suspected parathyroid adenoma, carried out from April 2014 to April 2018 in the Department of ENT & Head and Neck Surgery, National Academy of Medical Sciences(NAMS). Details of clinical data, biochemical investigations and radiological findings were recorded from all the cases. Final diagnosis was based on histopathological confirmation.

Results: Eleven patients underwent parathyroidectomy at our center in the last four years. Clinically three cases had history of recurrent renal stones, one had abdominal pain and two had pathological fracture and five cases were detected incidentally while doing routine biochemical investigations. All patients underwent minimal invasive parathyroidectomy. In all cases serum calcium and PTH level reduced except in one case that needed re – exploration and after revision surgery his serum calcium and PTH also decreased significantly. Histopathology of all cases reported as parathyroid adenoma including the case that underwent revision surgery. None of the case diagnosed as parathyroid hyperplasia and carcinoma in histopathology. Histopathology following second surgery in revision case reported as intrathyroidal parathyroid adenoma.

Conclusion: Parathyroid adenoma commonly presents with renal features. Some patients may remain asymptomatic. In all cases serum calcium and PTH was high before surgery. Parathyroidectomy is the mode of treatment. Intraoperative parathyroid hormone (ioPTH) assay improves the success rate of minimal invasive parathyroidectomy.

Keywords: Hypercalcemia, Hyperthyroidism, Parathyroid adenoma, Primary hyperparathyroidism