Outcome of Clinical Profile and Surgical Management of Parathyroid Adenoma: A Retrospective Study of 11 Cases

Abstract

Background: Parathyroid adenoma is a benign tumor of the parathyroid gland and the most common cause of primary hyperparathyroidism (pHPT). Although often asymptomatic, it may present with renal calculi, abdominal pain, or skeletal complications. Parathyroidectomy remains the definitive treatment.

Objectives: To evaluate the clinical presentation, diagnostic profile, surgical management, and outcomes of parathyroid adenoma.

Methods: A retrospective review was conducted on patients undergoing surgery for suspected parathyroid adenoma between January 2021 and January 2023 in the Department of ENT, Bangabandhu Sheikh Mujib Medical University (BSMMU). Demographics, clinical features, biochemical and radiological findings, operative details, and histopathological results were analyzed. Intraoperative parathyroid hormone (ioPTH) monitoring was used to assess surgical success.

Results: Eleven patients underwent parathyroidectomy. The mean age was 47.2 years (range: 30–63); six were male and five female. Clinical presentations included recurrent renal stones (3), abdominal pain (1), pathological fractures (2), and incidental detection (5). Ultrasonography localized adenomas in 9 cases, while 99mTc-MIBI scintigraphy was positive in all cases. Single gland involvement was noted in 9 patients, and multiple gland disease in 2. All patients underwent minimally invasive parathyroidectomy; ioPTH dropped >50% post-excision in every case. One patient required revision surgery for intrathyroidal adenoma, with successful outcome. Histopathology confirmed parathyroid adenoma in all cases; none showed carcinoma or hyperplasia. Postoperatively, serum calcium and PTH normalized in all patients.

Conclusion: Parathyroid adenoma commonly presents with renal manifestations, though many patients remain asymptomatic. Biochemical screening and imaging are vital for diagnosis. Minimally invasive parathyroidectomy, supported by ioPTH monitoring, is highly effective and safe, with excellent surgical outcomes.