Department of Surgery, University of Iowa, Iowa City, IA.
Surgery. 2013 Oct;154(4):714-8; discussion 718-9. doi: 10.1016/j.surg.2013.05.013. Epub 2013 Aug 23.
The size of abnormal parathyroid glands in patients with primary hyperparathyroidism (PHPT) is highly variable, but the clinical significance of giant glands is unknown.
We reviewed 300 consecutive patients after parathyroidectomy for PHPT. We compared patients with giant parathyroid adenomas (weight ≥95th percentile) with the remaining patients.
Giant adenomas were defined as weight ≥95th percentile or 3.5 g (median, 0.61; range, 0.05-29.93). Patients with giant adenomas had a greater mean preoperative calcium level, greater mean parathyroid hormone (PTH) level, and were less likely to have multiglandular or symptomatic disease. Giant adenomas were successfully localized on imaging in 87% of patients, which was not increased over other patients (82%). There were no differences between the groups in age, gender, gland location, or the incidence of persistent or recurrent hyperparathyroidism. Finally, giant glands had an increased incidence of symptomatic postoperative hypocalcemia, including 1 patient who required rehospitalization after removal of a giant gland.
Giant parathyroid adenomas have a distinct presentation characterized by single gland disease and lower incidence of symptoms despite increased levels of calcium and PTH. Additionally, after resection of a giant adenoma, patients are more likely to develop symptomatic hypocalcemia.
原发性甲状旁腺功能亢进症（PHPT）患者甲状旁腺腺体大小存在高度变异性，但巨型腺体的临床意义尚不清楚。
我们回顾了 300 例因 PHPT 接受甲状旁腺切除术的连续患者。我们比较了巨型甲状旁腺腺瘤（重量≥第 95 百分位数）患者与其余患者的情况。
巨型腺瘤定义为重量≥第 95 百分位数或 3.5 克（中位数为 0.61；范围为 0.05-29.93）。巨型腺瘤患者术前平均血钙水平更高，甲状旁腺激素（PTH）水平更高，且更不可能有多发性腺体疾病或有症状的疾病。在 87%的患者中成功定位了巨型腺瘤，这一比例与其他患者（82%）相比并没有增加。两组间在年龄、性别、腺体位置或持续性或复发性甲状旁腺功能亢进的发生率方面无差异。最后，巨型腺体术后发生症状性低钙血症的发生率增加，包括 1 例因切除巨型腺瘤而需要再次住院的患者。
尽管钙和 PTH 水平升高，但巨型甲状旁腺腺瘤具有独特的表现特征，表现为单发性腺体疾病，且症状发生率较低。此外，切除巨型腺瘤后，患者更有可能发生症状性低钙血症。
