Giant Parathyroid Adenoma Excised through Endoscopic Trans- Axillary Parathyroidectomy; A Case Report with Literature Review
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Abstract
Large parathyroid adenomas consist 1.5% of all adenomas. While minimally invasive parathyroidectomy is the method of choice with established advantages, surgeons prefer open surgery for large adenomas to reduce surgical risks. Here, we present a 41-year-old male with primary hyperparathyroidism due to large size parathyroid adenoma (3.2 cm) that was removed successfully by endoscopic trans-axillary parathyroidectomy. This presentation can guide surgeons to choose this minimally invasive technique, even for large adenomas.
1. Al-Hassan MS, Mekhaimar M, El Ansari W, Darweesh A, Abdelaal A. Giant parathyroid adenoma: a case report and review of the literature. J Med Case Rep. 2019;13(1):332. https://doi.org/10.1186/s13256-019-2257-7
2. Neagoe RM, Sala DT, Borda A, Mogoanta CA, Muhlfay G. Clinicopathologic and therapeutic aspects of giant parathyroid adenomas - three case reports and short review of the literature. Rom J Morphol Embryol. 2014;55(2 Suppl):669-674.
3. Power C, Kavanagh D, Hill AD, O’Higgins N, McDermott E. Unusual presentation of a giant parathyroid adenoma: report of a case. Surg Today. 2005;35(3):235-237. https://doi.org/10.1007/s00595-004-2902-6
4. Noureldine SI, Gooi Z, Tufano RP. Minimally invasive parathyroid surgery. Gland Surg. 2015;4(5):410-419.
5. Sephton B. Extracervical approaches to thyroid surgery: evolution and review. Minim Invasive Surg. 2019;2019:5961690. https://doi.org/10.1155/2019/5961690
6. Brunaud L, Li Z, Van Den Heede K, Cuny T, Van Slycke S. Endoscopic and robotic parathyroidectomy in patients with primary hyperparathyroidism. Gland Surg. 2016;5(3):352- 360. https://doi.org/10.21037/gs.2016.01.06
7. Christakis I, Michas S, Mouziouras V, Augoustis C, Dimas S. Minimally invasive techniques for giant parathyroid tumours; An oxymoron? Hellenic J Surg. 2012;84(4):220-224. https://doi.org/10.1007/s13126-012-0032-y
8. Meyer-Rochow G, Sidhu S, Delbridge L, Grodski S, Sywak M. ES12 Can giant parathyroid adenomas be safely removed by minimally invasive parathyroidectomy? ANZ J Surg. 2007;77(Suppl 1):A23. https://doi.org/10.1111/j.1445-2197.2007.04118_12.x
9. Mahmodlou R, Sedokani A, Pezeshk A, Najafinejad B. Giant parathyroid adenoma: a case report. J Med Case Rep. 2022;16(1):150. https://doi.org/10.1186/s13256-022-03401-y
10. Al-Hassan MS, Mekhaimar M, El Ansari W, Darweesh A, Abdelaal A. Giant parathyroid adenoma: a case report and review of the literature. J Med Case Rep. 2019;13(1):332. https://doi.org/10.1186/s13256-019-2257-7
11. Salehian M, Namdari O, Mohammadi SS, Fazaeli YH. Primary hyperparathyroidism due to a giant parathyroid adenoma: a case report. Tehran Univ Med J. 2009;67(4):293-297.
12. Shah S, Fujikawa P, Brand K, Munshi V, Patel K. Giant parathyroid adenoma: a case report. Cureus. 2023;15(1):e33546. https://doi.org/10.7759/cureus.34140
13. Rutledge S, Harrison M, O’Connell M, O’Dwyer T, Byrne MM. Acute presentation of a giant intrathyroidal parathyroid adenoma: a case report. J Med Case Rep. 2016;10(1):286. https://doi.org/10.1186/s13256-016-1078-1
14. Tolley N, Arora A, Palazzo F, Garas G, Dhawan R, Cox J, et al. Robotic-assisted parathyroidectomy: a feasibility study. Otolaryngol Head Neck Surg. 2011;144(6):859-866. https://doi.org/10.1177/0194599811402152
15. Tolley N, Garas G, Palazzo F, Prichard A, Chaidas K, Cox J, et al. Long-term prospective evaluation comparing robotic parathyroidectomy with minimally invasive open parathyroidectomy for primary hyperparathyroidism. Head Neck. 2016;38(Suppl 1):E300-E306. https://doi.org/10.1002/hed.23990
16. Foley CS, Agcaoglu O, Siperstein AE, Berber E. Robotic transaxillary endocrine surgery: a comparison with conventional open technique. Surg Endosc. 2012;26(8):2259-2266. https://doi.org/10.1007/s00464-012-2169-8
17. Kandil E, Hadedeya D, Shalaby M, Toraih E, Aparício D, Garstka M, et al. Robotic-assisted parathyroidectomy via transaxillary approach: feasibility and learning curves. Gland Surg. 2021;10(3):953-960. https://doi.org/10.21037/gs-20-761
18. Katz L, Abdel Khalek M, Crawford B, Kandil E. Robotic-assisted transaxillary parathyroidectomy of an atypical adenoma. Minim Invasive Ther Allied Technol. 2012;21(3):201-205. https://doi.org/10.3109/13645706.2011.581291
19. Sahsamanis G, Gkouzis K, Samaras S, Pinialidis D, Dimitrakopoulos G. Surgical management of a giant parathyroid adenoma through minimal invasive parathyroidectomy. A case report. Int J Surg Case Rep. 2017;31:262-265. https://doi.org/10.1016/j.ijscr.2017.01.064
20. Haldar A, Thapar A, Khan S, Jenkins S. Day-case minimally invasive excision of a giant mediastinal parathyroid adenoma. Ann R Coll Surg Engl. 2014;96(5):e21-e23. https://doi.org/10.1308/003588414X13946184900480
21. Wong HKG, Shipman K, Allan K, Ghabbour A, Borumandi F.Giant parathyroid tumours in primary hyperparathyroidism: a systematic review. Langenbecks Arch Surg. 2022;407(2):501- 516. https://doi.org/10.1007/s00423-021-02406-3
22. Power C, Kavanagh D, Hill AD, O’Higgins N, McDermott E. Unusual presentation of a giant parathyroid adenoma: report of a case. Surg Today. 2005;35(3):235-237. https://doi.org/10.1007/s00595-004-2902-6
23. Weng J, Zhou W, Feng Y. Giant cystic parathyroid adenoma: two case reports and a literature review. J Int Med Res. 2022;50(6):03000605221106419. https://doi. org/10.1177/03000605221106419
24. Neagoe RM, Sala DT, Borda A, Mogoanta CA, Muhlfay G. Clinicopathologic and therapeutic aspects of giant parathyroid adenomas-three case reports and short review of the literature. Rom J Morphol Embryol. 2014;55(2 Suppl):669-674.
25. Spanheimer PM, Stoltze AJ, Howe JR, Sugg SL, Lal G, Weigel RJ. Do giant parathyroid adenomas represent a distinct clinical entity? Surgery. 2013;154(4):714-719. https://doi.org/10.1016/j.surg.2013.05.013
26. Mantzoros I, Kyriakidou D, Galanos-Demiris K, Chatzakis C, Parpoudi S, Sapidis N, et al. A rare case of primary hyperparathyroidism caused by a giant solitary parathyroid adenoma. Am J Case Rep. 2018;19:1334-1340. https://doi.
org/10.12659/AJCR.911452.
2. Neagoe RM, Sala DT, Borda A, Mogoanta CA, Muhlfay G. Clinicopathologic and therapeutic aspects of giant parathyroid adenomas - three case reports and short review of the literature. Rom J Morphol Embryol. 2014;55(2 Suppl):669-674.
3. Power C, Kavanagh D, Hill AD, O’Higgins N, McDermott E. Unusual presentation of a giant parathyroid adenoma: report of a case. Surg Today. 2005;35(3):235-237. https://doi.org/10.1007/s00595-004-2902-6
4. Noureldine SI, Gooi Z, Tufano RP. Minimally invasive parathyroid surgery. Gland Surg. 2015;4(5):410-419.
5. Sephton B. Extracervical approaches to thyroid surgery: evolution and review. Minim Invasive Surg. 2019;2019:5961690. https://doi.org/10.1155/2019/5961690
6. Brunaud L, Li Z, Van Den Heede K, Cuny T, Van Slycke S. Endoscopic and robotic parathyroidectomy in patients with primary hyperparathyroidism. Gland Surg. 2016;5(3):352- 360. https://doi.org/10.21037/gs.2016.01.06
7. Christakis I, Michas S, Mouziouras V, Augoustis C, Dimas S. Minimally invasive techniques for giant parathyroid tumours; An oxymoron? Hellenic J Surg. 2012;84(4):220-224. https://doi.org/10.1007/s13126-012-0032-y
8. Meyer-Rochow G, Sidhu S, Delbridge L, Grodski S, Sywak M. ES12 Can giant parathyroid adenomas be safely removed by minimally invasive parathyroidectomy? ANZ J Surg. 2007;77(Suppl 1):A23. https://doi.org/10.1111/j.1445-2197.2007.04118_12.x
9. Mahmodlou R, Sedokani A, Pezeshk A, Najafinejad B. Giant parathyroid adenoma: a case report. J Med Case Rep. 2022;16(1):150. https://doi.org/10.1186/s13256-022-03401-y
10. Al-Hassan MS, Mekhaimar M, El Ansari W, Darweesh A, Abdelaal A. Giant parathyroid adenoma: a case report and review of the literature. J Med Case Rep. 2019;13(1):332. https://doi.org/10.1186/s13256-019-2257-7
11. Salehian M, Namdari O, Mohammadi SS, Fazaeli YH. Primary hyperparathyroidism due to a giant parathyroid adenoma: a case report. Tehran Univ Med J. 2009;67(4):293-297.
12. Shah S, Fujikawa P, Brand K, Munshi V, Patel K. Giant parathyroid adenoma: a case report. Cureus. 2023;15(1):e33546. https://doi.org/10.7759/cureus.34140
13. Rutledge S, Harrison M, O’Connell M, O’Dwyer T, Byrne MM. Acute presentation of a giant intrathyroidal parathyroid adenoma: a case report. J Med Case Rep. 2016;10(1):286. https://doi.org/10.1186/s13256-016-1078-1
14. Tolley N, Arora A, Palazzo F, Garas G, Dhawan R, Cox J, et al. Robotic-assisted parathyroidectomy: a feasibility study. Otolaryngol Head Neck Surg. 2011;144(6):859-866. https://doi.org/10.1177/0194599811402152
15. Tolley N, Garas G, Palazzo F, Prichard A, Chaidas K, Cox J, et al. Long-term prospective evaluation comparing robotic parathyroidectomy with minimally invasive open parathyroidectomy for primary hyperparathyroidism. Head Neck. 2016;38(Suppl 1):E300-E306. https://doi.org/10.1002/hed.23990
16. Foley CS, Agcaoglu O, Siperstein AE, Berber E. Robotic transaxillary endocrine surgery: a comparison with conventional open technique. Surg Endosc. 2012;26(8):2259-2266. https://doi.org/10.1007/s00464-012-2169-8
17. Kandil E, Hadedeya D, Shalaby M, Toraih E, Aparício D, Garstka M, et al. Robotic-assisted parathyroidectomy via transaxillary approach: feasibility and learning curves. Gland Surg. 2021;10(3):953-960. https://doi.org/10.21037/gs-20-761
18. Katz L, Abdel Khalek M, Crawford B, Kandil E. Robotic-assisted transaxillary parathyroidectomy of an atypical adenoma. Minim Invasive Ther Allied Technol. 2012;21(3):201-205. https://doi.org/10.3109/13645706.2011.581291
19. Sahsamanis G, Gkouzis K, Samaras S, Pinialidis D, Dimitrakopoulos G. Surgical management of a giant parathyroid adenoma through minimal invasive parathyroidectomy. A case report. Int J Surg Case Rep. 2017;31:262-265. https://doi.org/10.1016/j.ijscr.2017.01.064
20. Haldar A, Thapar A, Khan S, Jenkins S. Day-case minimally invasive excision of a giant mediastinal parathyroid adenoma. Ann R Coll Surg Engl. 2014;96(5):e21-e23. https://doi.org/10.1308/003588414X13946184900480
21. Wong HKG, Shipman K, Allan K, Ghabbour A, Borumandi F.Giant parathyroid tumours in primary hyperparathyroidism: a systematic review. Langenbecks Arch Surg. 2022;407(2):501- 516. https://doi.org/10.1007/s00423-021-02406-3
22. Power C, Kavanagh D, Hill AD, O’Higgins N, McDermott E. Unusual presentation of a giant parathyroid adenoma: report of a case. Surg Today. 2005;35(3):235-237. https://doi.org/10.1007/s00595-004-2902-6
23. Weng J, Zhou W, Feng Y. Giant cystic parathyroid adenoma: two case reports and a literature review. J Int Med Res. 2022;50(6):03000605221106419. https://doi. org/10.1177/03000605221106419
24. Neagoe RM, Sala DT, Borda A, Mogoanta CA, Muhlfay G. Clinicopathologic and therapeutic aspects of giant parathyroid adenomas-three case reports and short review of the literature. Rom J Morphol Embryol. 2014;55(2 Suppl):669-674.
25. Spanheimer PM, Stoltze AJ, Howe JR, Sugg SL, Lal G, Weigel RJ. Do giant parathyroid adenomas represent a distinct clinical entity? Surgery. 2013;154(4):714-719. https://doi.org/10.1016/j.surg.2013.05.013
26. Mantzoros I, Kyriakidou D, Galanos-Demiris K, Chatzakis C, Parpoudi S, Sapidis N, et al. A rare case of primary hyperparathyroidism caused by a giant solitary parathyroid adenoma. Am J Case Rep. 2018;19:1334-1340. https://doi.
org/10.12659/AJCR.911452.
| Files | ||
| Issue | Vol 9 No 1 (2026) | |
| Section | Case Report(s) | |
| Keywords | ||
| Parathyroid Neoplasms; Parathyroid Neoplasms; Parathyroidectomy, Endoscopic Parathyroidectomy Parathyroid Neoplasms Parathyroidectomy Endoscopic Parathyroidectomy | ||
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How to Cite
1.
dahmardeh ali, Nasiri S, Moslemi S, Sharghi S, Yaghoobi Notash A. Giant Parathyroid Adenoma Excised through Endoscopic Trans- Axillary Parathyroidectomy; A Case Report with Literature Review. AJS. 2026;9(1):50-56.
