Liu P, Vakharia N, Zacharia A, Rogers M, Tanweer F
Nottingham University Hospitals NHS Trust, UK.
United Lincolnshire Hospitals NHS Trust, UK.
Ann R Coll Surg Engl. 2020 Jul;102(6):e111-e114. doi: 10.1308/rcsann.2020.0043. Epub 2020 Apr 1.
Bilateral giant parathyroid adenoma in the absence of multiple endocrine neoplasia (MEN) type 1 is extremely rare and literature on this subject is limited.
A 79-year-old man presented with acute kidney injury secondary to hypercalcaemia. Blood test results indicated primary hyperparathyroidism. Ultrasonography revealed bilateral parathyroid adenomas measuring 19.4mm x 19.5mm x 18.8mm (left) and 15.2mm x 18.3mm x 19.6mm (left) whereas on computed tomography, the measurements were 31mm x 20mm (left) and 30mm x 14mm (right). Intraoperatively, giant adenomas measuring 50mm x 25mm x 12mm (left, weighing 8.101g) and 48mm x 22mm x 10mm (right, weighing 7.339g) were identified and excised. Parathyroid hormone level dropped from 44.6pmol/l preoperatively to 8.9pmol/l postoperatively (normal range 1.3-7.6pmol/l). The patient was discharged with no complications.
We report a rare phenomenon where bilateral giant parathyroid adenoma occurred in the absence of MEN type 1. It highlights the importance of cross-sectional imaging in delineating the anatomy of adenomas as their size can be grossly underestimated by ultrasonography alone.
在无1型多发性内分泌腺瘤病（MEN）的情况下双侧巨大甲状旁腺腺瘤极为罕见，关于这一主题的文献有限。
一名79岁男性因高钙血症继发急性肾损伤就诊。血液检查结果提示原发性甲状旁腺功能亢进。超声检查显示双侧甲状旁腺腺瘤，左侧大小为19.4mm×19.5mm×18.8mm，右侧大小为15.2mm×18.3mm×19.6mm；而计算机断层扫描显示左侧大小为31mm×20mm，右侧大小为30mm×14mm。术中发现并切除了巨大腺瘤，左侧大小为50mm×25mm×12mm（重8.101g），右侧大小为48mm×22mm×10mm（重7.339g）。甲状旁腺激素水平从术前的44.6pmol/l降至术后的8.9pmol/l（正常范围为1.3 - 7.6pmol/l）。患者出院，无并发症。
我们报告了一种罕见现象，即在无1型MEN的情况下发生双侧巨大甲状旁腺腺瘤。这突出了断层成像在描绘腺瘤解剖结构方面的重要性，因为仅靠超声检查可能会严重低估腺瘤的大小。
