The presence of 2 parathyroid adenomas is a rare but documented condition. It must be distinguished from hyperplasia of the parathyroid glands, which is more common.
Criteria for the diagnosis of double parathyroid adenomas:
(1) presence of 2 parathyroid glands that are enlarged and histologically abnormal
(2) the remaining glands must be normal or atrophic (not hyperplastic)
(3) negative family history of parathyroid disease (exclude MEN syndromes)
(4) permanent cure on long term followup after excision of the 2 adenomas
Persistence of hyperparathyroidism:
(1) A second parathyroid adenoma may be found if evidence of hyperparathyroidism persists after removal of the first adenoma.
(2) Persistence of hyperparathyroidism after excision of the second "adenoma" favors hyperplasia.
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