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Surgical challenges of giant parathyroid adenomas weighing 10 g or more

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Abstract

Purpose

An average parathyroid adenoma (PA) weighs < 1 g. This study aimed to characterise giant PAs ≥ 10 g (GPAs) to facilitate surgical management of primary hyperparathyroidism (PHPT).

Methods

All patients with a GPA confirmed on histology were recruited from the Monash University Endocrine Surgery Unit database. Clinical and demographic data were collected and compared to a group of non-GPA patients.

Results

A total of 14 GPAs were identified between 2007 and 2018 out of 863 patients (1.6%) with a single PA excised for PHPT. The GPA patients were compared to a control group of 849 non-GPA patients in the same period with similar mean age (62 ± 16 vs 63 ± 14, P = 0.66) and gender distribution (64% vs 75% female, P = 0.35). Pre-operative calcium (Ca) and parathyroid hormone (PTH) levels were significantly higher in GPA patients (P < 0.001). A higher percentage of GPA patients (79%) had concordant localisation studies (ultrasound and sestamibi) than control patients (59%), (P = 0.13), but they were significantly less likely to undergo MIP (55% vs 82%, P = 0.02). The median GPA weighed 12.5 g (IQR 10.5–24.3). Median serum Ca normalised by day 1 post-operatively, while PTH remained elevated. Both serum Ca and PTH levels were in the normal range at 3 months. All GPA lesions were benign on histopathology.

Conclusion

GPAs are rare and display severe clinical and biochemical abnormalities. Despite their large size, concordant pre-operative imaging was not always achieved, and a few patients were suitable for MIP.

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Data availability

The datasets used during the current study are available from the corresponding author on reasonable request.

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Funding

No funding was sought for this project.

Author information

Authors and Affiliations

  1. Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, VIC, Australia

    S. Prabhakaran, C. Bhatt, J. W. Serpell, S. Grodski & J. C. Lee

  2. School of Clinical Sciences of Monash Health, Monash University, Victoria, Australia

    C. Bhatt

  3. Central Clinical School, Department of Surgery, Monash University, Victoria, Australia

    J. W. Serpell, S. Grodski & J. C. Lee

Authors
  1. S. Prabhakaran
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  2. C. Bhatt
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  3. J. W. Serpell
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  4. S. Grodski
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  5. J. C. Lee
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Contributions

All authors contributed substantially to this project in terms of conception, design of the work, analysis and interpretation of data, and writing of the manuscript. All authors approved the final manuscript.

Corresponding author

Correspondence to S. Prabhakaran.

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The authors declare that they have no competing interests.

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Ethics approval was obtained from the Alfred Health Ethics Committee (Reference Number 606/19).

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For this type of study, consent is not needed.

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Prabhakaran, S., Bhatt, C., Serpell, J.W. et al. Surgical challenges of giant parathyroid adenomas weighing 10 g or more. J Endocrinol Invest 46, 1169–1176 (2023). https://doi.org/10.1007/s40618-022-01968-3

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  • DOI: https://doi.org/10.1007/s40618-022-01968-3

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