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.

中文翻译：

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自发性包膜外甲状旁腺腺瘤出血：何时需要手术？

目的

自发性出血是甲状旁腺腺瘤罕见但严重的并发症，文献报道的病例很少。临床表现和治疗可能会有所不同，但有时需要立即手术。在其他情况下，根据临床稳定性和患者状况，可以首选保守方法。这项工作的目的是描述我们的案例并对当前有关该主题的文献进行回顾。

方法

我们报告了一例描述其治疗的老年患者甲状旁腺腺瘤出血的病例。此外，还对 57 例病例进行了文献回顾，旨在收集有关最受累的甲状旁腺的数据，并根据临床表现和选择的治疗方法确定最正确的治疗方案。

结果

患者年龄在 29 至 81 岁之间（平均 56.9 ± 16.4 岁）。44 名患者为女性（77.2%），而 12 名患者为男性（21.8%）。根据临床严重程度、年龄、合并症和钙血症状态，确定了三种可能的情况，每种情况都有推荐的管理方法。

结论

在甲状旁腺腺瘤出血中，仔细的临床评估对于确定需要立即插管、气管切开术或颈部探查的紧急情况至关重要。老年人和合并症患者围手术期并发症的风险较高，应根据具体情况评估手术指征：只要可行，这些受试者应首选保守治疗，尤其是病程稳定且无高钙血症相关症状的患者。