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Spontaneous extracapsular parathyroid adenoma hemorrhage: when surgery is required?

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Abstract

Purpose

Spontaneous bleeding is a rare but serious complication of parathyroid adenomas and few cases were reported in the literature. Clinical manifestations and treatment may vary but sometimes an immediate surgery is required. In other cases a conservative approach can be preferred based on clinical stability and patients’ conditions. The purpose of this work is to describe our case and to carry out a review of the current literature on this topic.

Methods

We reported a case of a parathyroid adenoma hemorrhage in an elderly patient describing its management. Moreover, a literature review of 57 cases was carried out, with the aim of collecting data about the most involved parathyroid gland and identifying the most correct management based on clinical manifestations and chosen treatments.

Results

The patients had an age between 29 and 81 years (mean 56.9 ± 16.4 years). Forty-four patients were females (77.2%), whereas 12 were males (21.8%). Based on clinical severity, age, comorbidities and calcemic status, three possible scenarios were identified, each with a recommended management.

Conclusions

In parathyroid adenoma hemorrhages a careful clinical assessment is crucial to identify emergency conditions requiring immediate intubation, tracheostomy or neck exploration. Elderlies and comorbid patients have a higher risk of perioperative complications and indication for surgery should be evaluated case by case: whenever feasible, a conservative approach should be preferred in these subjects, especially in those with a stable course and without hypercalcemia-related symptoms.

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Authors and Affiliations

  1. Department of Otolaryngology-Head and Neck Surgery, Scientific Institute of Hospitalization and Care San Raffaele Hospital, Vita-Salute University, Milan, Italy

    Marco Familiari, Andrea Galli, Giulia Danè, Leone Giordano & Mario Bussi

  2. Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, via Manzoni 56 Rozzano, 20089, Milan, Italy

    Davide Di Santo

  3. Department of Radiology, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy

    Renata Mellone

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by M.F., D.D.S., A.G., G.D., L.G. and R.M. The first draft of the paper was written by M.F., D.D.S. and A.G. and all authors commented on previous versions of the paper. Tables were made by M.F., A.G. and G.D. The supervision was performed by M.B. and L.G. All authors read and approved the final paper.

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Correspondence to Marco Familiari.

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Familiari, M., Di Santo, D., Galli, A. et al. Spontaneous extracapsular parathyroid adenoma hemorrhage: when surgery is required?. Endocrine 75, 575–582 (2022). https://doi.org/10.1007/s12020-021-02876-x

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