Clinical Features and Management of Rare Giant Parathyroid Adenoma: A Case Series

Parathyroid glands present with a wide spectrum of diseases that mainly influence the calcium and phosphate metabolism of the body. In response to low calcium levels in the blood, the parathyroid gland secretes a polypeptide called parathyroid hormone (PTH). The normal parathyroid gland weighs approximately 20-40 mg. Parathyroid adenomas are usually small, measuring < 2 cm and weighing < 1 gm. Giant parathyroid adenomas, although rare, are most commonly defined as weighing more than 3.5 gm or size greater than 2 cm in largest dimension. Both parathyroid adenomas and giant parathyroid adenomas present with the syndrome of primary hyperparathyroidism, which is the third most common endocrine disorder. Although primary hyperparathyroidism can be caused by parathyroid hyperplasia or parathyroid carcinoma, however, around 85% of cases are due to parathyroid adenomas. Giant parathyroid adenomas are frequently associated with more severe forms of the disease, such as osteitis fibrosa cystica (OFC), and they share numerous biochemical, histological, and molecular characteristics. In this case series, 11 cases of this rare giant parathyroid adenoma presented themselves in the OPD of Department of Surgery (Breast & Endocrine Surgery unit) at a tertiary care institute over a 3-year period. The case series highlights their clinical features at the time of presentation, complications and co-morbidities. All of them underwent surgical resection and symptoms subsided after surgery.