Original communicationDouble adenomas revisited: Nonuniform distribution favors enlarged superior parathyroids (fourth pouch disease)☆
Section snippets
Methods
This retrospective, 2-institution study covers 828 unselected patients with HPT treated at Emory University Hospital (1993–2002) and The Cleveland Clinic (1999–2002). Parathyroidectomy was performed by a single endocrine surgeon at each institution (C.J.W. at Emory; A.S. at The Cleveland Clinic). During this time period, the surgical approach in both institutions consisted of bilateral open neck exploration. Preoperative technetium 99 metastable (Tc99m)-sestamibi imaging, ultrasonography, and
Overview of clinical features
Of 828 consecutive cases of HPT, DAs were found in 127 patients (15%), SAs in 592 patients (71%), MGH in 107 patients (13%); 2 patients had negative explorations (1%). Patients with DA were predominantly women (110 of 127, 87%) aged 59±13 years. The female gender distribution and age of DA patients were not statistically different than those observed in patients with SA (77% women, 60±14 years) and MGH (76% women, 62.7±13 years).
Diagnostic elevations of serum calcium and PTH for DA patients
Discussion
In this large cohort of patients with HPT, the distinct entity of 2 abnormal parathyroid glands was encountered in 15% of cases. DAs were most likely to be found involving both superior parathyroid glands and were more likely to harbor larger glands at these locations. This pattern of distribution indicates that double parathyroid adenomas do not follow uniform allocation as previously assumed.
Upon closer inspection of reported series of DAs (Table II), our findings are not necessarily
Conclusion
DAs are a distinct entity of multigland hyperparathyroidism that can potentially exist in 1 out of every 7 neck explorations. DAs have a nonuniform distribution that shows increased probability of involving both sides of the neck, with the most prevalent location affecting both superior parathyroid glands. These observations confirm the need for a meticulous search and identification of all parathyroid glands at initial operation. Unilateral neck exploration guided by Tc99m-sestamibi and
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Bilateral exploration in primary hyperparathyroidism: Double adenoma distribution and biochemical patterns over two decades
2024, American Journal of SurgeryDouble adenoma as a cause of primary hyperparathyroidism: Asymmetric hyperplasia or a distinct pathologic entity?
2021, American Journal of SurgeryCitation Excerpt :Published data are mixed regarding the distribution of abnormal glands in DA. While several groups have found that abnormal glands occurred in a disproportionately bilateral superior distribution, others reported disproportionately crossed bilateral/asymmetric adenomas.8,16,17 Importantly, we found no association between the anatomic distribution of DA and risk of persistence/recurrence.
Surgical Pathology of the Parathyroid Glands
2021, Surgery of the Thyroid and Parathyroid GlandsSurgical Management of Multiglandular Parathyroid Disease
2021, Surgery of the Thyroid and Parathyroid Glands
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Presented at the 24th Annual Meeting of the American Association of Endocrine Surgeons, San Diego, California, May 11-14, 2003.