Clinical analysis of primary parathyroid adenomas:a report of 273 cases
Huang Xiaotian1, Zhang Yongxia2, Ma Bing1, Zou Guijun1, Zhao Jiandong2, Zong Liang2, Du Xiaohui1, Liu Mingbo2
1College of General Surgery, the First Medical Center of Chinese PLA General Hospital, Beijing 100853,China; 2College of Otolaryngology Head and Neck Surgery, the Sixth Medical Center of Chinese PLA General Hospital, Beijing 100853, China
Abstract：Objective This study aimed to explore the clinical characteristics, diagnosis, and treatment of primary parathyroid adenomas (PPTAs). Methods A total of 273 patients with PPTAs confirmed by surgery and pathology in the Department of General Surgery and Otorhinolaryngology Head and Neck Surgery of PLA General Hospitalfrom from December 2005 to December 2020 were analyzed retrospectively. Of the 273 patients, 90 were male and 183 were female aged 15 to 78 (50.7±13.5) years. Their disease duration ranged from 0.2 to 216.0 (20.8±34.3) months. The tumors of all patients were removed by minimally invasive parathyroidectomy. In addition, the clinical symptoms and signs, imaging features, primary serum biochemicals before and after surgery, operation, and prognosis were observed. Results (1) A total of 118 patients (43.2%) were asymptomatic, and the other 155 patients (56.8%) reported chest and abdominal pain, low back pain, systemic bone pain, myalgia, arthralgia, upper and lower limb pain, etc. (2) Radiological examintion showed that 99.2% (256/258) of patients had abnormal results as confirmed by pre-operative thyroid ultrasound check; 94.5% (172/182) of patients had an abnormal concentration of radioactive substances in parathyroid radiation as confirmed by scintigraphy; 94.1% (128/136) of patients had thyroid and parathyroid masses and urinary tract stones as confirmed by CT scans; 92.9% (13/14) of patients had thyroid and parathyroid masses as shown in MRI, and 83.9% (52/62) of patients showed skull, limb bones, spine bones, and pelvic bones by X-ray, and 84.6% (33/39) showed osteoporosis by bone density testing. (3) The serum calcium and phosphorusand parathyroid hormone of patients after surgery improved significantly compared with those before surgery (all P values<0.001), but serum alkaline phosphatase showed no significant difference before and after operation (P>0.05). (4) All 273 patients underwent surgery successfully. The location of the tumor site was determined during surgery, with 34.4% (94/273) on the right and left lobes lateral and inferior to the thyroid gland, 12.5% (34/273) on the right lobe lateral and superior to the thyroid gland, 9.5% (26/273) on the left lobe lateral and superior to the thyroid gland, and 9.2% (25/273) on other sites at the thyroid gland. A total of 36 patients showed hypocalcemia symptoms 24 h after surgery. In addition, 189 pateints were followed by 1 to 13 (6.3±2.4) years, during which seven patients suffered from hypocalcemia numbness and convulsions, five patients suffered from hoarseness and cough, three patients relapsed, seven patients died of other diseases, and the remaining patients were tumor free. Conclusion The clinical manifestations of PPTA are nonspecific. More than 40% of patients are asymptomatic, and they can be diagnosed by imaging examination and laboratory tests. Surgery is the primary treatment of PPTA, and the prognosis is good after operation.
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2023, Vol. 28 
