[Giant parathyroid tumors: characterization of 26 glands weighing more than 3.5 grams]

Abstract

Aim of the study: To determine the characteristics of giant lesions of the parathyroid glands weighting more than 3.5 g.

Patients and method: Twenty-six patients operated on between 1989 to 2001 were included in this retrospective study. Anatomical, biological, clinical and histological parameters were analyzed. Data were compared both with a personnal series of the last 220 patients with hyperparathyroidism operated on in our department and with the results of a primary hyperparathyroidism multicentric study conducted by the French Association of Surgery (AFC).

Results: They were 14 females and 12 males with a mean age of 58.57 +/- 13.72 years (ranged: 26-80). Mean weight of the parathyroid glands was 9.87 +/- 9.76 g (ranged: 3.5-40). The diagnosis of parathyroid disease was suspected by symptoms and incidentally discovered hypercalcemia in 17 and 8 cases respectively. In one case, the adenoma was misdiagnosed as a thyroid nodule. Mean calcemia was 125.42 +/- 19.6 mg/L, mean phosphoremia was 21.6 +/- 6.9 mg/L, mean seric parathormone concentration was 451.44 +/- 530.18 ng/L. Comparing with our personnel 220 HPT-series, they was no statistically difference concerning the mean age, but number of males and biological measurements were significantly higher in presence of a giant adenoma. Comparing with the study of the AFC group, there was no statistically difference concerning the symptoms, especially in regard to the asymptomatic forms discovered by hypercalcemia and to the acute hypercalcemia forms. Minor ectopic localizations were found in half of the cases. All the glands were considered as beginnings. After surgery, one patient had a severe hypocalcemia in relation to a hungry bone syndrome.

Conclusion: Giant adenomas have no specific symptoms even if functional status seems to be more active. Diagnosis is made during the sixth decade as usual. Male people are more often concerned. At surgery ectopic localizations are present in 50% of the cases. In our study their size is not a sign of malignancy. After surgery severe hypocalcemia can occur if a long past of bone disease exists.