Parathyroid Adenoma: A Comprehensive Biochemical and Histological Correlative Study

Abstract

Objective

To investigate the controversial relationship between preoperative calcium and parathyroid hormone levels and the dimensions and histologic features of parathyroid adenoma in patients with primary hyperparathyroidism.

Study design

Historical cohort.

Setting

Tertiary medical center.

Subjects and Methods

Clinical and tumor-related data were collected from the medical files of all patients who underwent parathyroidectomy for primary hyperparathyroidism in 1996 -2012. Preoperative blood parathyroid hormone and calcium levels and urine calcium levels were correlated with the size, weight, and volume of the parathyroid adenoma. Pathohistological features were determined in a representative sample of archived paraffin-embedded sections and analyzed by calcium or parathyroid hormone level (high/low) and adenoma weight (high/low).

Results

A total of 378 patients were included. There was a statistically significant direct correlation of preoperative calcium and parathyroid hormone levels with tumor dimensions and of tumor weight and chief-cell percentage. At a preoperative calcium level >11.5 mg/dl and PTH level >165 mg/dl, we predict that the adenoma would measure more than 2.7 g, 2.18 cm and volume of 3.59 cm³.

Conclusions

In patients with primary hyperparathyroidism, preoperative calcium and PTH levels may be predictive of parathyroid adenoma dimensions.

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