Turkish Journal of Surgery

Turkish Journal of Surgery

ISSN: 2564-6850
e-ISSN: 2564-7032

 

Fatih Kuzu1, Dilek Arpacı1, Güldeniz Karadeniz Çakmak3, Rabia Uslu4, Ali Uğur Emre3, Sevil Uygun İlikhan2, Mehmet Çabuk4, Taner Bayraktaroğlu1

1Department of Endocrinology and Metabolism, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey
2Department of Internal Medicine, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey
3Department of General Surgery, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey
4Department of Nuclear Medicine, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey

Abstract

Solitary parathyroid adenomas are a common cause of primary hyperparathyroidism (pHPT). Double parathyroid adenomas have a reported frequency of under 12% in pHPT. We present the case of a 45-year-old female patient admitted with weakness, fatigue, and generalized bone pain. She had been treated for nephrolithiasis five times in the last two years, had high levels of serum calcium and parathyroid hormone, a low level of 25-hydroxy vitamin D, and osteoporosis diagnosed by bone densitometry. Neck ultrasonography revealed bilateral parathyroid adenomas, confirmed by technetium-99m-sestamibi scintigraphy on the left. Findings on the right were suspicious, but not diagnostic. The parathyroid hormone washout concentrations were 1989 pg/mL (left) and 2097 pg/mL (right). A bilateral parathyroidectomy was performed. Intraoperative ultrasonography revealed a third retrosternal lesion, which was removed. All three specimens were confirmed as parathyroid adenomas on histology. Intraoperative neck ultrasonography thus played a crucial role in preventing secondary surgical intervention.

Keywords: Double, intraoperative ultrasonography, parathyroid adenomas, triple

This study was presented at the 17th European Congress of Endocrinology, 16-20 May 2015, Dublin, Ireland.
Cite this paper as: Kuzu F, Arpacı D, Karadeniz Çakmak G, Uslu R, Emre AU, Uygun İlikhan S, Çabuk M, Bayraktaroğlu T. Preoperative double adenoma upgraded to a triple adenoma after intraoperative sonographic evaluation of the neck. Turk J Surg 2018; DOI: 10.5152/UCD.2015.3244