Parathyroid Hyperplasia Parathyroidectomy

More than one abnormal parathyroid gland is present in about 20% of patients with primary hyperparathyroidism (HPT) and in virtually all patients with secondary HPT. When all parathyroid glands are enlarged and hyperplastic, these patients have diffuse hyperplasia. In some patients with primary or secondary hyperplasia, the size of the parathyroid glands varies considerably. More than one abnormal parathyroid gland may occur in patients with other histologically proven normal parathyroid glands; these patients have double or triple adenomas.1

Problems exist that contribute to the controversy as to how patients with primary and secondary HPT and multiple abnormal parathyroid glands should be managed. For example, patients with familial parathyroid disease are more likely to have multiple abnormal parathyroid glands (=80%) and experience recurrent disease than are patients with sporadic disease.2,3 There is also no consensus as to the precise size of the parathyroid remnant to leave at subtotal parathyroidectomy, the precise amount of parathyroid tissue to autotransplant, and the site to autotransplant into during total parathyroidectomy with autotransplantation. We recommend parathyroid cryopreservation for all patients having subtotal or total parathyroidectomy with autotransplantation in case the parathyroid remnant or autotransplanted tissue does not function adequately. Long-term follow-up studies are also necessary to determine the incidence of hypoparathyroidism and recurrent or persistent HPT after subtotal or total parathyroidectomy with autotransplantation. Better histologic and molecular biologic criteria must be developed to determine precisely whether an abnormal parathyroid gland is an adenoma or a hyperplastic gland.

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