Distribution of solitary parathyroid adenoma over the parathyroid glands and its surgical management

Abstract

Objective: To determine the distribution of solitary parathyroid adenoma over the parathyroid glands in a group of patients with primary hyperparathyroidism Design: A case-series.

Place and duration of study: Departments of Surgery and Pathology at Shariati Hospital, Tehran, Iran, between the years 1981 and 2003.

Patients and methods: A retrospective review of surgery reports of 118 patients with primary hyperparathyroidism was performed. All of the patients had solitary parathyroid adenoma and the anatomical location of each adenoma was clearly defined during operation. Serum calcium, phosphorus and parathormone levels along with clinical characteristics were also included.

Results: The distribution of adenomas over the superior and inferior parathyroid glands showed a significant higher incidence of adenoma in the lower parathyroids (p < 0.001). The right to left distribution of adenomas was not significant (p=0.4).

Conclusion: Surgical exploration for primary hyperparathyroidism should be initiated from the lower parathyroid glands provided that pre-operative localization scans are not helpful.