Relationships of clinical, laboratory and imaging findings in patients with parathyroid adenoma

Objective: We examined laboratory results, clinical, radiologic and histopathologic findings for patients who had undergone operation for parathyroid adenoma. Our purpose is evaluating the relations between these findings in this study. Materials and Method: This study was performed on 169 patients who were followed up for hyperparathyroidisim in Gaziantep University Medical Faculty, Department of Endocrinology between January 2010 and December 2016. We analyzed separately 71 patients who have parathyroid adenoma after successful surgery. Clinical records were examined for symptoms, concomitant diseases, laboratory results (serum intact PTH, calcium, phosphorus, creatinin, vitamin D, ALP, TSH, fT3, fT4, calcitonin, 24-hour urine calcium, 24-hour urine creatinin), bone mineral density measurements, operation reports, ultrasonographic, scintigraphic and histopathologic findings. Results: In our study, 62 (87%) of 71 patients who have parathyroid adenoma were female and 9 (13%) male. Their mean age was 52 years. Asymptomatic patients was found 35% of all patients. Fatigue(24%) and bone pain(18%) were the most common symptoms. Renal calculi was found in 10% of patients. Pathological fracture was not seen in patients with parathyroid adenoma. Plain radiograph of the fingers demonstrated subperiosteal bone resorption of the phalanges at 34% of patients. Osteoporosis rate was 37% with forearm bone mineral density measurements. Hypertension (28%), diabetes mellitus(18%) and multinodular goiter(18%) were established as the most common comorbidities. There was no patient with pancreatitis. Papillary thyroid carcinoma was seen 12,7% of patients. Also 36% of patients underwent thyroidectomy and parathyroidectomy. Two of all patients were with MEN1 syndrome and one of all patients was with MEN2A syndrome. Serum intact PTH was significiantly higher in patients with Vitamin D deficiency(p=0,010). Preoperative serum calcium and PTH measurements were correlated positively with parathyroid adenoma size(p=0,005, p=0,000). Also preoperative PTH measurements were correlated positively with parathyroid adenoma weight(p=0,030). One of all patients covered criterions for normocalcemic primary hyperparathyroidisim. Serum Ca/P ratio was correlated positively with PTH(p=0,037). The sensitivity of USG and 99mTcSestamibi scan for the localization of adenoma was 86,2% and 92,6%, respectively. Ultrasonographic and scintigraphic findings were complementary for each other. Conclusion: The most common signs were osteoporosis and nephrolithiasis for patients with parathyroid adenoma. If there is an elevated serum calcium concentration on biochemical screening tests, asymptomatic PHPT should also be remembered. Preoperative serum calcium and PTH measurements seem likely to estimate the size of parathyroid adenoma. Vitamin D should be measured with all patients who are suspected for primary hyperparathyroidism. Ultrasonographic and 99mTcSestamibi scan findings should be evaluated together for parathyroid adenoma. Before parathyroidectomy, patients should be examined for thyroid gland. Serum Ca/P ratio was correlated positively with PTH. On the basis of this result, Ca/P ratio may predict hyperparathyroidism especially for normocalcemic patients. It is thought that further investigations are needed about this subject.