Multiple parathyroid adenomas

A case is reported of a sixty-two-year-old male who had pulmonary tuberculosis twenty-five years before admission to the hospital; a left nephrotomy for the removal of multiple renal calculi twenty-one years ago; and who subsequently developed a bladder calculus with all the signs and symptoms of hyperparathyroidism. The first operation at which only the right side of the neck was explored, resulted in the removal of a parathyroid adenoma. However, the symptoms persisted as did the hypercalcemia and the elevated serum phosphatase. A second operation seven weeks later failed to reveal a second parathyroid adenoma. Further studies were continued, the patient meanwhile showing no improvement, and it was decided to reoperate a third time. A large parathyroid tumor containing remnants of thymus tissue was found on the left side. The patient died shortly afterward with evidence of cardiac failure. The question of what influence, if any, the treatment for pulmonary tuberculosis with its high caloric diet and increased milk intake, and subsequent load on the parathyroids, is properly raised. Also the long-standing interval between the appearance of the renal calculi twenty-one years before, and the subsequent development of the typical signs and symptoms of hyperparathyroidism is discussed. Attention is called to the fact that an exhaustive exploration must be done thoroughly on both sides even though a large tumor may be readily found on one side. Cope's admonition that the problems of parathyroid surgery are not those of the regional anatomy of the neck, but are peculiar to the anatomy and physiology of the parathyroid glands, should be emphasized. Likewise special training is required for this type of surgery.