Roses D F, Karp N S, Sudarsky L A, Valensi Q J, Rosen R J, Blum M
Department of Surgery, New York University Medical Center, NY 10016.
Arch Surg. 1989 Nov;124(11):1261-5. doi: 10.1001/archsurg.1989.01410110015002.
An increasingly recognized although small percentage of patients with primary hyperparathyroidism have enlargement of two parathyroid glands. We have treated nine patients with primary hyperparathyroidism associated with such double parathyroid gland enlargement. In four of these patients, marked asymmetry of the two enlarged glands was noted and the failure to recognize and excise a second enlarged parathyroid gland resulted in persistent or recurrent hyperparathyroidism. In one of these patients, the second enlargement was present in a super-numerary mediastinal gland. The subsequent excision of the second enlarged parathyroid gland resulted in normocalcemia in each instance. This contrasts with five patients in whom initial excision of two enlarged glands resulted in normocalcemia with no recurrence of hypercalcemia. Only three patients fulfilled the histologic criteria of true double adenomas. The remainder showed multiglandular hypercellularity. This experience supports identifying all parathyroid glands and recognizing that even minimal enlargement of a gland may be important pathophysiologically, regardless of its histopathologic classification. Excision of both enlarged glands, even if asymmetric, is appropriate.
虽然仅有小部分原发性甲状旁腺功能亢进患者甲状旁腺双腺增大，但这一情况日益受到关注。我们治疗了9例与甲状旁腺双腺增大相关的原发性甲状旁腺功能亢进患者。其中4例患者，两个增大的腺体存在明显不对称，未能识别并切除第二个增大的甲状旁腺导致甲状旁腺功能亢进持续或复发。在其中1例患者中，第二个增大的腺体位于额外的纵隔腺体内。随后切除第二个增大的甲状旁腺后，每例患者血钙均恢复正常。这与另外5例患者形成对比，这5例患者最初切除两个增大的腺体后血钙恢复正常，高钙血症未复发。只有3例患者符合真正双腺瘤的组织学标准。其余患者表现为多腺体细胞增多。这一经验支持识别所有甲状旁腺，并认识到即使腺体最小程度的增大在病理生理上可能也很重要，无论其组织病理学分类如何。切除两个增大的腺体，即使不对称，也是合适的。
