Background: Giant parathyroid adenomas represent a distinct clinical entity forming a subset under primary hyperparathyroidism (PHPT). They comprise lesions weighing more than 3.5 g. Our study aims to determine the clinical presentation, biochemical profile, outcomes, and pathological characterization of patients with giant parathyroid adenoma.

Materials and methods: Retrospective review of data of patients who underwent parathyroid surgery between January 1995 and December 2022 by a single surgeon. A total of 561 patients were identified, and out of these, 78 had glands measuring more than 3.5 g.

Results: The mean age was 42 years, and 51 (65%) were females. The most common complaint was bone pain (46%), followed by renal calculi (38%), with 15 (19%) patients presenting with hypercalcemic crisis. Median calcium value was 12.3 mg/dL, with median PTH, vitamin D, and ALP of 1025 pg/mL, 23 ng/mL, and 664 U/L, respectively. Fifty-three (68%) patients underwent focused parathyroidectomy, and 22 (28%) underwent neck exploration, with median postoperative calcium and PTH being 8.35 mg/dL and 37.8 pg/mL, respectively. The median weight was 7 g with a range from 3.58 g to a whopping 31 g. Symptomatic postoperative hypocalcemia was seen in 54 (69%), with 28 (36%) requiring intravenous calcium supplementation, and this was positively correlated with the preoperative ALP and PTH values.

Conclusion: Giant parathyroid adenomas present with florid symptoms with hypercalcemia and often hypercalcemic crisis. The biochemical workup, localization, and surgical management are similar to any other case of PHPT. Postoperatively these patients are prone to hypocalcemia, and the intravenous requirement of calcium can be predicted by preoperative ALP levels.

Keywords: giant parathyroid adenoma; hypercalcemic crisis; localization; primary hyperparathyroidism.

© 2025 International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).

背景： 巨大甲状旁腺腺瘤代表了一种特定的临床实体，是原发性甲状旁腺功能亢进症（PHPT）的一个亚型。它们指的是重量超过3.5克的病变。本研究旨在确定患有巨大甲状旁腺腺瘤患者的临床表现、生化特征、结果和病理特征。

材料与方法： 回顾性分析1995年1月至2022年12月由一位外科医生进行的甲状旁腺手术的数据。共确定了561例患者，其中78例患者的病变重量超过3.5克。

结果： 平均年龄为42岁，女性占51名（65%）。最常见的主诉是骨痛（46%），其次是肾结石（38%），有15名患者（19%）出现高钙血症危象。平均血清钙值为12.3 mg/dL，平均PTH、维生素D和ALP分别为1025 pg/mL、23 ng/mL 和 664 U/L。53名（68%）患者接受了聚焦性甲状旁腺切除术，22名（28%）患者进行了颈部探查手术，术后血钙和PTH的中位值分别降至8.35 mg/dL 和 37.8 pg/mL。病变平均重量为7克，范围从3.58克到惊人的31克不等。术后出现症状性低钙血症的比例为54名（69%），其中28名患者（36%）需要静脉注射补钙，并且这与术前ALP和PTH值呈正相关。

结论： 巨大甲状旁腺腺瘤常伴有明显的高钙血症症状，有时还会出现高钙血症危象。生化检测、定位以及手术管理与其他PHPT病例相似。术后患者容易发生低钙血症，并且术前ALP水平可以预测静脉补钙需求。

关键词： 巨大甲状旁腺腺瘤；高钙血症危象；定位；原发性甲状旁腺功能亢进。