CLINICAL AND SURGICAL ASPECTS OF DOUBLE ADENOMA IN PATIENTS WITH PRIMARY HYPERPARATHYROIDISM

The incidence of double parathyroid andenoma in 277 prospectively docu mented patients suffering from primary hyperparathyroidism was 5.4 per cent (15 patients). Patients with double adenoma were all symptomatic and had a significantly higher parathyroid hormone (PTH) level and tu mour weight than those with a solitary adenoma or four-gland hyperplas ia. In 11 patients the adenomas were located bilaterally. Bilateral ne ck exploration must be performed rotinely to deal successfully with th is condition at initial operation. In six patients one enlarged gland was found in the thymus or posterior mediastinum. These locations shou ld be explored, especially in patients with high PTH levels, in those in whom all four parathyroid glands cannot be detected or if only one small adenoma is found. In all such patients, selective resection of t he enlarged parathyroid glands resulted in normocalcaemia (median foll ow-up 3.5 years). Selective resection of the pathological glands is th e treatment of choice.