Bilateral exploration in primary hyperparathyroidism: Double adenoma distribution and biochemical patterns over two decades

• Published in: The American journal of surgery Vol. 233; pp. 61 - 64
• Main Authors: Beck, Tim N., Romero-Velez, Gustavo, Noureldine, Salem I., Plitt, Gilman, Wang, Sarah, Jin, Judy
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2024; Elsevier Limited
• Subjects: Adenoma; Bilateral exploration; Biochemistry; Double adenoma; Exploration; Hyperparathyroidism; Hyperplasia; Multi-gland hyperplasia; Osteoporosis; Parathyroid hormone; Parathyroidectomy; Patients; Primary hyperparathyroidism; Surgery; Tumors; United States > US; Primary hyperparathyroidism; Double adenoma; Parathyroidectomy; Bilateral exploration; Multi-gland hyperplasia
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2024.02.008

We investigated if anatomic patterns of abnormal parathyroid glands have ch anged for primary hyperparathyroidism (pHPT) as atypical biochemical presentation (normohormonal and normocalcemic) has increased. Retrospective review of patients with pHPT who underwent routine bilateral neck exploration. 2762 patients were included. The “late” cohort (2014–2020) exhibited lower preoperative calcium (10.8 vs 11.1 ​mg/dL; P ​= ​0.001) and PTH levels (101 vs. 146 ​pg/mL; P ​= ​0.001) compared to the “early” cohort (2000–2006). Patients with atypical biochemical profiles increased from 25.5% to 31.3% (P ​< ​0.001). The prevalence of single adenoma (SA) decreased (66.1% vs 58.9%, P ​= ​0.02) while the proportion of double adenoma (DA) increased (17.3% vs. 22.6%, P ​< ​0.01). Upper parathyroid adenoma(s) remained the most common finding for SA and DA in both time points. Despite changes in patient characteristics, single upper adenoma and bilateral double upper adenomas remain the most common findings for patients with pHPT. •Changes in the biochemical profiles of patients with sporadic pHPT have been observed.•Abnormal upper glands were more common in patients with single or double adenoma.•The proportion of patients with double adenoma (DA) has increased significantly (22.6% vs. 17.3%; P ​< ​0.01).•Knowledge of anatomic patterns for parathyroid adenomas can assist with surgical decision making.