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. 2025 Apr;77(2):381-388.
doi: 10.1007/s13304-025-02086-4. Epub 2025 Jan 30.

Correlation between parathyroid adenoma volume and perioperative outcomes in primary hyperparathyroidism: Does the size matter?

Antonio Fiore #  1   2 , Sophie Eschlböck #  3   4 , Céline Carlen  4 , Ioannis I Lazaridis  3   4   5 , Alexandros Lalos  3   4 , Raoul Droeser  4 , Tarik Delko #  4   6 , Alberto Posabella #  3   4
Affiliations

Correlation between parathyroid adenoma volume and perioperative outcomes in primary hyperparathyroidism: Does the size matter?

Antonio Fiore et al. Updates Surg. 2025 Apr.

Abstract

Background: Primary hyperparathyroidism (PHPT) due to a parathyroid adenoma stands as one of the most prevalent endocrinological disorders, with focused parathyroidectomy being the established therapeutic strategy.

Aim: This study aims to investigate whether the volume of the pathological gland influences perioperative outcomes and postoperative morbidity.

Methods: A retrospective analysis was conducted on data from 141 patients who underwent focused parathyroidectomy for PHPT at the University Hospital of Basel between 2007 and 2022.

Results: A total of 141 patients underwent surgery, with a mean age of 57.2 years and prevalence of women (64.5%).The volume of the lesion was divided into three groups (low < 1 ml, middle 1-1.99 ml, large > 2 ml) based on pathological specimen analysis. Preoperative calcium and parathyroid hormone (PTH) values were significantly higher in the large volume group compared to the low volume group (p < 0.05), while phosphate and vitamin D values were significantly lower (p < 0.05). A comparison of adenoma volume in symptomatic patients with asymptomatic patients revealed no statistically significant difference (p = 0.845) and the volume of the gland of any group did not influence the length of the operation (p = 0.173) and the perioperative morbidity (p = 0.108).

Conclusion: Compared to a volume of less than 1 ml, a parathyroid gland volume greater than 2 ml was associated with higher preoperative PTH and calcium levels and lower phosphate and vitamin D levels. The volume of the parathyroid gland does not seem to impact the clinical manifestations, or the incidence of perioperative complications.

Keywords: Parathyroid adenoma; Parathyroidectomy; Postoperative complications; Primary hyperparathyroidism.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare that they have no conflict of interest. Research involving human participants and/or animals: The ethics committee and review board in our institute approved the study and treatment protocol. Informed consent: Informed consent was obtained from all patients who agreed to participate in the study.

Figures

Fig. 1
Fig. 1
Volume of pathological specimen according to the clinical manifestations of PHPT
Fig. 2
Fig. 2
Correlation between the volume of parathyroid adenoma and preoperative PTH
Fig. 3
Fig. 3
Correlation between the volume of parathyroid adenoma and intraoperative drop of PTH
Fig. 4
Fig. 4
Correlation between the volume of parathyroid adenoma and preoperative Calcium
Fig. 5
Fig. 5
Correlation between the volume of parathyroid adenoma and preoperative phosphate
Fig. 6
Fig. 6
Correlation between the volume of parathyroid adenoma and preoperative vitamin D
See this image and copyright information in PMC

References

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