Abstract
Complications related to parathyroid surgery are rare but most commonly include recurrent laryngeal nerve injury, hematoma formation, and hypocalcemia. In highly experience centers, >95 % of patients are normocalcemic postoperatively. Parathyroid hormone (PTH) on the other hand remains elevated in a significant number of patients with normocalcemia after parathyroidectomy. Primary hyperparathyroidism (PHPT) is due to a single parathyroid adenoma in most patients, with a chief cell adenoma being the most common pathologic variant. However, oxyphil adenomas, lipoadenomas, clear cell adenomas, and atypical parathyroid adenomas can also be seen. Parathyroid carcinoma and parathyromatosis are other pathologic entities that should be considered in persistent and recurrent PHPT. Parathyroid hyperplasia is the cause of PHPT in approximately 15 % of patients and is seen in familial parathyroid disorders such as MEN1, MEN2A, MEN4, hyperparathyroidism-jaw tumor syndrome, and familial isolated PHPT.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Wermers RA, Kearns AE, Jenkins GD, Melton 3rd LJ. Incidence and clinical spectrum of thiazide-associated hypercalcemia. Am J Med. 2007;120:911 e919–915.
Christensen SE, Nissen PH, Vestergaard P, Mosekilde L. Familial hypocalciuric hypercalcaemia: a review. Curr Opin Endocrinol Diabetes Obes. 2011;18:359–70.
Arnold A, Marx SJ. Familial primary hyperparathyroidism (Including MEN, FHH, and HPT-JT). In: Primer on the metabolic bone diseases and disorders of mineral metabolism. 8th ed. Ames: Wiley; 2013. p. 553–61.
Kunstman JW, Kirsch JD, Mahajan A, Udelsman R. Clinical review: parathyroid localization and implications for clinical management. J Clin Endocrinol Metab. 2013;98:902–12.
Udelsman R, Lin Z, Donovan P. The superiority of minimally invasive parathyroidectomy based on 1650 consecutive patients with primary hyperparathyroidism. Ann Surg. 2011;253:585–91.
Pathak PR, Holden SE, Schaefer SC, Leverson G, Chen H, Sippel RS. Elevated parathyroid hormone after parathyroidectomy delays symptom improvement. J Surg Res. 2014;190:119–25.
Carsello CB, Yen TW, Wang TS. Persistent elevation in serum parathyroid hormone levels in normocalcemic patients after parathyroidectomy: does it matter? Surgery. 2012;152:575–81; discussion 581–3.
Erickson LA. Atlas of endocrine pathology. New York: Springer; 2014. p. 103.
Rosai J DR, Carcangiu ML, Frable WJ, Tallini G. Tumors of the thyroid and parathyroid glands (AFIP atlas of tumor pathology: series 4). American Registry of Pathology, Silver Spring, MD (Maryland); 2015, p. 513.
Bedetti CD, Dekker A, Watson CG. Functioning oxyphil cell adenoma of the parathyroid gland: a clinicopathologic study of ten patients with hyperparathyroidism. Hum Pathol. 1984;15:1121–6.
Akerstrom G, Rudberg C, Grimelius L, et al. Histologic parathyroid abnormalities in an autopsy series. Hum Pathol. 1986;17:520–7.
Erickson LA, Jin L, Papotti M, Lloyd RV. Oxyphil parathyroid carcinomas: a clinicopathologic and immunohistochemical study of 10 cases. Am J Surg Pathol. 2002;26:344–9.
Fleischer J, Becker C, Hamele-Bena D, Breen TL, Silverberg SJ. Oxyphil parathyroid adenoma: a malignant presentation of a benign disease. J Clin Endocrinol Metab. 2004;89:5948–51.
Giorgadze T, Stratton B, Baloch ZW, Livolsi VA. Oncocytic parathyroid adenoma: problem in cytological diagnosis. Diagn Cytopathol. 2004;31:276–80.
Howson PKS, Aniss A, Pennington T, Gill AJ, Dodds T, Delbridge LW, Sidhu SB, Sywak MS. Oxyphil cell parathyroid adenomas causing primary hyperparathyroidism: a clinico-pathological correlation. Endocr Pathol. 2015;26:250–4.
Chow LS, Erickson LA, Abu-Lebdeh HS, Wermers RA. Parathyroid lipoadenomas: a rare cause of primary hyperparathyroidism. Endocr Pract. 2006;12:131–6.
Abul-Haj SK, Conklin H, Hewitt WC. Functioning lipoadenoma of the parathyroid gland. Report of a unique case. N Engl J Med. 1962;266:121–3.
Rosai J DR, Carcangiu ML, Frable WJ, Tallini G. Tumors of the thyroid and parathyroid glands (AFIP atlas of tumor pathology: series 4). American Registry of Pathology Silver Spring, MD (Maryland); 2015. p. 532.
Fernandez-Ranvier GG, Khanafshar E, Jensen K, et al. Parathyroid carcinoma, atypical parathyroid adenoma, or parathyromatosis? Cancer. 2007;110:255–64.
Bondeson L, Sandelin K, Grimelius L. Histopathological variables and DNA cytometry in parathyroid carcinoma. Am J Surg Pathol. 1993;17:820–9.
Schantz A, Castleman B. Parathyroid carcinoma. A study of 70 cases. Cancer. 1973;31:600–5.
Marcocci C, Cetani F, Rubin MR, Silverberg SJ, Pinchera A, Bilezikian JP. Parathyroid carcinoma. J Bone Miner Res. 2008;23:1869–80.
Lentsch EJ, Withrow KP, Ackermann D, Bumpous JM. Parathyromatosis and recurrent hyperparathyroidism. Arch Otolaryngol Head Neck Surg. 2003;129:894–6.
Conflict of Interest
All authors state that they have no conflicts of interest.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Mayo Foundation for Medical Education and Research
About this chapter
Cite this chapter
Wermers, R.A., Erickson, L.A. (2016). Parathyroidectomy Outcomes and Pathology in Primary Hyperparathyroidism. In: Kearns, A., Wermers, R. (eds) Hyperparathyroidism. Springer, Cham. https://doi.org/10.1007/978-3-319-25880-5_6
Download citation
DOI: https://doi.org/10.1007/978-3-319-25880-5_6
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-25878-2
Online ISBN: 978-3-319-25880-5
eBook Packages: MedicineMedicine (R0)