Correlation between parathyroid adenoma volume and perioperative outcomes in primary hyperparathyroidism: Does the size matter?

Background
Primary hyperparathyroidism (PHPT) due to a parathyroid adenoma stands as one of the most prevalent endocrinological disorders, with focused parathyroidectomy being the established therapeutic strategy.Aim
This study aims to investigate whether the volume of the pathological gland influences perioperative outcomes and postoperative morbidity.Methods
A retrospective analysis was conducted on data from 141 patients who underwent focused parathyroidectomy for PHPT at the University Hospital of Basel between 2007 and 2022.Results
A total of 141 patients underwent surgery, with a mean age of 57.2 years and prevalence of women (64.5%).The volume of the lesion was divided into three groups (low < 1 ml, middle 1-1.99 ml, large > 2 ml) based on pathological specimen analysis. Preoperative calcium and parathyroid hormone (PTH) values were significantly higher in the large volume group compared to the low volume group (p < 0.05), while phosphate and vitamin D values were significantly lower (p < 0.05). A comparison of adenoma volume in symptomatic patients with asymptomatic patients revealed no statistically significant difference (p = 0.845) and the volume of the gland of any group did not influence the length of the operation (p = 0.173) and the perioperative morbidity (p = 0.108).Conclusion
Compared to a volume of less than 1 ml, a parathyroid gland volume greater than 2 ml was associated with higher preoperative PTH and calcium levels and lower phosphate and vitamin D levels. The volume of the parathyroid gland does not seem to impact the clinical manifestations, or the incidence of perioperative complications.