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An Approach to a Patient With Primary Hyperparathyroidism and a Suspected Ectopic Parathyroid Adenoma.
- Source :
-
The Journal of clinical endocrinology and metabolism [J Clin Endocrinol Metab] 2022 May 17; Vol. 107 (6), pp. 1706-1713. - Publication Year :
- 2022
-
Abstract
- Primary hyperparathyroidism (PHPT) is characterized by hypercalcemia driven by excess parathyroid hormone (PTH) secretion. PHPT is a common endocrine condition with a prevalence of 1 to 7 cases per 1000 adults. PHPT typically presents in the fifth or sixth decade and shows significant female preponderance. Solitary hyperfunctioning parathyroid adenomas account for 85% to 90% of PHPT cases. The remaining 10% to 15% include cases of multiglandular disease (multiple adenomas or hyperplasia) and, rarely, parathyroid carcinoma (1%). Ectopic parathyroid adenomas may arise due to abnormal embryological migration of the parathyroid glands and can be difficult to localize preoperatively, making surgical cure challenging on the first attempt. The potential existence of multiglandular disease should be considered in all patients in whom preoperative localization fails to identify a target adenoma or following unsuccessful parathyroidectomy. Risk factors for multiglandular disease include underlying genetic syndromes (eg, MEN1/2A), lithium therapy, or previous radiotherapy. In addition to multifocal disease, the possibility of an ectopic parathyroid gland should also be considered in patients requiring repeat parathyroid surgery. In this article, we use illustrative clinical vignettes to discuss the approach to a patient with primary hyperparathyroidism (PHPT) and a suspected ectopic parathyroid adenoma.<br /> (© The Author(s) 2022. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
- Subjects :
- Adult
Female
Humans
Parathyroid Glands surgery
Parathyroid Hormone
Parathyroidectomy adverse effects
Adenoma complications
Adenoma diagnosis
Adenoma surgery
Hyperparathyroidism, Primary complications
Hyperparathyroidism, Primary diagnosis
Parathyroid Neoplasms complications
Parathyroid Neoplasms diagnosis
Parathyroid Neoplasms surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1945-7197
- Volume :
- 107
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- The Journal of clinical endocrinology and metabolism
- Publication Type :
- Academic Journal
- Accession number :
- 35150267
- Full Text :
- https://doi.org/10.1210/clinem/dgac024