An approach to a patient with primary hyperparathyroidism and a suspected ectopic parathyroid adenoma.
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Authors
Glasgow, Clarke
Lau, Eunice YC
Harper, Ines
Cheow, Heok
Das, Tilak
Berman, Laurence
Powlson, Andrew S
Bashari, Waiel
Challis, Benjamin G
Marker, Alison
Moyle, Penelope
Mohamed, Isra
Schoenmakers, Nadia
Broomfield, Jonathan
Oddy, Sue
Moran, Carla
Jani, Piyush
Masterson, Liam
Fish, Brian
Publication Date
2022-02-12Journal Title
J Clin Endocrinol Metab
ISSN
0021-972X
Publisher
The Endocrine Society
Type
Article
This Version
AM
Metadata
Show full item recordCitation
Glasgow, C., Lau, E. Y., Aloj, L., Harper, I., Cheow, H., Das, T., Berman, L., et al. (2022). An approach to a patient with primary hyperparathyroidism and a suspected ectopic parathyroid adenoma.. J Clin Endocrinol Metab https://doi.org/10.1210/clinem/dgac024
Abstract
Primary hyperparathyroidism (PHPT) is characterised by hypercalcemia driven by excess parathyroid hormone (PTH) secretion. PHPT is a common endocrine condition with a prevalence of one to seven cases per 1000 adults. PHPT typically presents in the fifth or sixth decade and shows significant female preponderance. Solitary hyper-functioning parathyroid adenomas account for 85-90% of PHPT cases. The remaining 10-15% include cases of multi-glandular disease (multiple adenomas or hyperplasia) and, rarely, parathyroid carcinoma (1%). Ectopic parathyroid adenomas may arise due to abnormal embryological migration of the parathyroid glands and can be difficult to localise pre-operatively, making surgical cure challenging on the first attempt. The potential existence of multiglandular disease should be considered in all patients in whom pre-operative localization fails to identify a target adenoma, or following unsuccessful parathyroidectomy. Risk factors for multiglandular disease include underlying genetic syndromes (e.g., MEN1/2A), lithium therapy, or previous radiotherapy. In addition to multifocal disease, the possibility of an ectopic parathyroid gland should also be considered in patients requiring repeat parathyroid surgery. In this article, we use illustrative clinical vignettes to discuss the approach to a patient with PHPT and a suspected ectopic parathyroid adenoma.
Embargo Lift Date
2023-02-12
Identifiers
External DOI: https://doi.org/10.1210/clinem/dgac024
This record's URL: https://www.repository.cam.ac.uk/handle/1810/332754
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