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The American Journal of Case Reports Nov 2018BACKGROUND Solitary parathyroid adenomas are the leading cause of primary hyperparathyroidism in 0% to 85% of cases. Diagnosis of parathyroid adenoma is based on typical... (Review)
Review
BACKGROUND Solitary parathyroid adenomas are the leading cause of primary hyperparathyroidism in 0% to 85% of cases. Diagnosis of parathyroid adenoma is based on typical clinical presentation of hypercalcemia, biochemical profile, and modern imaging studies. The purpose of this article is to present the diagnostic and therapeutic approach used for a 73-year-old female patient with a giant parathyroid adenoma measuring 5×2.5×2.5 cm and weighing 30 grams. CASE REPORT A 73-year-old female was referred to the outpatient clinic of our Surgical Department with the diagnosis of primary hyperparathyroidism. The patient suffered from typical symptoms of hypercalcemia such as weakness, bone disease, and recurrent nephrolithiasis; she had a painless cervical mass for 5 months. Primary hyperparathyroidism was confirmed based on the patient's biochemical profile, which showed increased levels of serum calcium and parathyroid hormone. SestaMIBI scintigraphy with 99mTechnetium and cervical ultrasonography revealed a large nodule at the inferior pole of the right lobe of the thyroid gland. Intraoperatively, a giant parathyroid adenoma was found and excised. Additionally, levels of intact parathyroid hormone (IOiPTH) were determined intraoperatively and a 95% reduction was found, 20 minutes after the removal of the adenoma. CONCLUSIONS This is an extremely rare case of a giant solitary parathyroid adenoma. Diagnosis of a giant hyperfunctioning solitary parathyroid adenomas was based on clinical presentation, biochemical profile, and imaging studies. Selective treatment was based on surgical excision combined with IOiPTH levels measurement.
Topics: Adenoma; Aged; Female; Follow-Up Studies; Humans; Hyperparathyroidism, Primary; Parathyroid Neoplasms; Parathyroidectomy; Rare Diseases; Risk Assessment; Treatment Outcome
PubMed: 30405093
DOI: 10.12659/AJCR.911452 -
Medicina Clinica Dec 2020
Topics: Adenoma; Humans; Hyperparathyroidism, Primary; Parathyroid Neoplasms
PubMed: 31757395
DOI: 10.1016/j.medcli.2019.09.008 -
The British Journal of Oral &... Dec 2019Ectopic parathyroid adenomas that affect the submandibular region have not been widely reported. We describe a 34-year-old man who presented with a painless swelling of...
Ectopic parathyroid adenomas that affect the submandibular region have not been widely reported. We describe a 34-year-old man who presented with a painless swelling of the submandibular region. The identification of hypercalcaemia encouraged us to engage a multidisciplinary team to evaluate further serum changes. Parathyroid hormone analysis, Tc-methoxy-isobutyl-isonitrile (Tc-MIBI) scintigraphy, and single-photon emission computed tomography (SPECT-CT) were done to rule out hyperparathyroidism. Raised parathyroid hormone together with Tc-MIBI and SPECT-CT examination were consistent with a tumour caused by the hyperparathyroidism. Removal of the lesion resulted in rapid improvement in serum calcium and parathyroid hormone, and the normalisation of the serum creatinine, concentrations. Histopathological analysis confirmed a parathyroid adenoma. We conclude that ectopic parathyroid adenomas should be considered as part of a differential diagnosis for tumours of the submandibular region.
Topics: Adenoma; Adult; Humans; Hypercalcemia; Male; Parathyroid Glands; Parathyroid Neoplasms; Radiopharmaceuticals; Technetium Tc 99m Sestamibi; Tomography, Emission-Computed, Single-Photon
PubMed: 31668332
DOI: 10.1016/j.bjoms.2019.10.296 -
Endocrine Practice : Official Journal... 2005To describe the clinical course of a patient with atypical cystic parathyroid adenoma manifesting as hypercalcemic parathyroid crisis. (Review)
Review
OBJECTIVE
To describe the clinical course of a patient with atypical cystic parathyroid adenoma manifesting as hypercalcemic parathyroid crisis.
METHODS
We present a case report and review the relevant literature on parathyroid cysts and atypical cystic parathyroid adenomas.
RESULTS
A 76-year-old woman was evaluated for weakness, weight loss, urinary incontinence, and memory disturbances. She had severe hypercalcemia (calcium level, 18.3 mg/dL) in conjunction with an elevated parathyroid hormone level of 1,472 pg/mL. She received aggressive hydration, pamidronate, and calcitonin. Ultrasonography revealed a large cystic structure (5.8 cm) at the lower pole of the left thyroid lobe. She underwent surgical exploration of the neck, total thyroidectomy for multinodular disease of the thyroid, and subtotal parathyroidectomy. Intraoperatively, 25 mL of fluid was aspirated from the cystic mass, and the parathyroid hormone level in the fluid was 7,400,000 pg/mL. The final pathologic diagnosis was an atypical cystic parathyroid adenoma.
CONCLUSION
Parathyroid cysts are uncommon and should be considered in the differential diagnosis of a neck mass. Although most parathyroid cysts are nonfunctional, 10% to 15% of such cysts are functional and can rarely manifest as acute parathyroid crisis. Atypical cystic parathyroid adenomas are rare and have an unpredictable clinical course. They exhibit some features of carcinoma but lack the indisputable evidence of malignant disease, such as angioinvasion or metastatic involvement. Treatment options for parathyroid cysts include aspiration, injection of sclerosing agents, and surgical excision.
Topics: Aged; Female; Follicular Cyst; Humans; Parathyroid Hormone; Parathyroid Neoplasms
PubMed: 16638726
DOI: 10.4158/EP.11.6.389 -
Endocrine Journal 2013A 46 year-old male presented with persistently high level of serum parathyroid hormone (PTH), despite successful resection of an oxyphilic cell parathyroid adenoma of... (Review)
Review
A 46 year-old male presented with persistently high level of serum parathyroid hormone (PTH), despite successful resection of an oxyphilic cell parathyroid adenoma of the left lower gland. Renal function and serum calcium were normal, leading to vitamin D deficiency being considered. Tc99m-sestamibi parathyroid scintigraphy showed no capitation, but a cervical ultrasound demonstrated an increase in the lower parathyroids. Surgery confirmed that the right gland was normal but the left corresponded to parathyroid carcinoma. The patient developed severe hypocalcemia, with PTH values being consistent with hypoparathyroidism for a few months. However, a progressive increase in calcium and PTH serum levels indicated recurrence of disease. Tc99m-sestamibi scintigraphy demonstrated hyperfixation in topography of the left inferior parathyroid and the patient was subjected to a third and more extensive surgery, with removal of lymph nodes and adjacent thyroid tissue. Serum calcium and PTH remained elevated, requiring loop diuretics and intravenous bisphosphonates to control hypercalcemia. Cervical radiotherapy was implemented as adjuvant therapy. After two months the patient complained of dyspnea, and a CT scan of the chest demonstrated areas of parenchymal condensation, suggestive of actinic pneumonitis. At the 2-year follow-up no major issues were evident.
Topics: Adenoma, Oxyphilic; Brazil; Carcinoma; Delayed Diagnosis; Diagnostic Errors; Humans; Hyperparathyroidism, Primary; Hypocalcemia; Male; Middle Aged; Neoplasms, Multiple Primary; Parathyroid Neoplasms; Radiotherapy, Adjuvant; Recurrence; Treatment Outcome
PubMed: 23268928
DOI: No ID Found -
Clinical Nuclear Medicine Jul 2005A 54-year-old woman was referred for imaging studies after presentation for palpitations and a palpable thyroid nodule. The patient underwent a dual-phase single-agent...
A 54-year-old woman was referred for imaging studies after presentation for palpitations and a palpable thyroid nodule. The patient underwent a dual-phase single-agent Tc-99m sestamibi scan followed later by a thyroid ultrasound at an outside hospital. The Tc-99m sestamibi scan showed a marked focus of activity separate from the thyroid bed in the inferior left neck. Thyroid ultrasound showed a dominant calcified nodule in the left lobe of the thyroid, measuring 1.3 cm, as well as 3-mm cystic lesions in both lobes of the thyroid. Also, an iodine-123 scan was performed showing a cold nodule in the left inferior thyroid. During surgery, the patient underwent a left thyroid lobectomy for an intrathyroidal parathyroid adenoma.
Topics: Adenoma; Female; Humans; Hyperparathyroidism; Middle Aged; Parathyroid Neoplasms; Thyroid Neoplasms; Thyroidectomy; Treatment Outcome
PubMed: 15965320
DOI: 10.1097/01.rlu.0000167481.79767.93 -
Journal of Medical Case Reports Sep 2023There is some evidence supporting the idea that double parathyroid adenomas represent a different entity from multiglandular hyperplasia; however, the distinction among...
BACKGROUND
There is some evidence supporting the idea that double parathyroid adenomas represent a different entity from multiglandular hyperplasia; however, the distinction among them is not straightforward.
CASE PRESENTATION
We described a case of primary hyperparathyroidism (PHPT) with pronounced clinical manifestations, caused by a bilateral giant parathyroid adenoma. A 34-year-old Hispanic/Latino male was diagnosed with PHPT caused by two giant parathyroid adenomas. The preoperative tests were neck ultrasound and computed tomography scan (CT-scan), showing two masses in the territory of parathyroid glands, bilaterally distributed (right was 31 × 18 × 19 mm and the left was 38 × 15 × 14 mm); sestamibi scan was not available. Parathyroid hormone (PTH) was highly elevated. Multiple complications of PHPT were present, such as bone lytic lesions, renal and pancreatic calcifications, and cardiovascular disease, the latter of which is an overlooked complication of PHPT. Multiple endocrine neoplasia 1 and 2 (MEN 1/2) were ruled out by the absence of clinical, biochemical, and radiological findings in other endocrine glands. The patient underwent subtotal parathyroidectomy with an intraoperative histopathological study; both intraoperative and definitive histopathology results were consistent with parathyroid adenomas; afterward, adequate suppression of PTH was assured, and later on, the patient presented hungry bone syndrome (HBS).
CONCLUSIONS
The diagnosis of double parathyroid adenomas is difficult. Regarding the similarities between multiglandular hyperplasia and parathyroid adenomas, this case report contributes to the further distinction between these two clinical entities. This case report also represents, in particular, the challenge of difficult diagnosis in places with limited resources, such as developing countries.
Topics: Humans; Adult; Parathyroid Neoplasms; Hyperplasia; Hypocalcemia; Bone Diseases; Parathyroid Hormone
PubMed: 37653552
DOI: 10.1186/s13256-023-04102-w -
Neuroimaging Clinics of North America May 2022Parathyroid imaging is predominantly used for preoperative localization of parathyroid lesions in patients with the biochemical diagnosis of primary hyperparathyroidism.... (Review)
Review
Parathyroid imaging is predominantly used for preoperative localization of parathyroid lesions in patients with the biochemical diagnosis of primary hyperparathyroidism. Although imaging algorithms vary, in the era of minimally invasive parathyroidectomy for single parathyroid adenomas, multiphase parathyroid computed tomography (CT) (4-dimensional CT) has emerged as a favored modality for presurgical mapping of parathyroid lesions. Implementation and correct interpretation of these studies can be challenging, although confidence and accuracy improve with experience and volume. This article reviews our approach to parathyroid imaging, focusing on pearls and pitfalls in parathyroid CT with ultrasound as a supportive and complementary modality.
Topics: Adenoma; Four-Dimensional Computed Tomography; Humans; Hyperparathyroidism, Primary; Parathyroid Glands; Parathyroid Neoplasms
PubMed: 35526965
DOI: 10.1016/j.nic.2022.01.006 -
Medicine Feb 2019Spontaneous anterior cervical or mediastinal hemorrhage is a rare presentation of parathyroid adenoma.
RATIONALE
Spontaneous anterior cervical or mediastinal hemorrhage is a rare presentation of parathyroid adenoma.
PATIENT CONCERNS
A 69-year-old woman presented with neck hematoma and dysphagia and was found to have a soft tissue mass adjacent to her thyroid gland as seen on MRI and neck ultrasound.
DIAGNOSIS
Laboratory testing demonstrated elevated calcium and parathyroid hormone supporting diagnosis of parathyroid adenoma.
INTERVENTIONS
She underwent right inferior parathyroidectomy and en bloc right hemithyroidectomy due to significant fibrosis.
OUTCOMES
Pathology confirmed hypercellular parathyroid and normal thyroid tissue. Postoperatively, patient's calcium and parathyroid hormone levels had normalized.
LESSONS
In conclusion, imaging may not always be specific in identifying the source of neck hematoma and so laboratory studies should be done to rule out parathyroid adenoma as the underlying etiology.
Topics: Adenoma; Aged; Female; Hematoma; Humans; Mediastinal Diseases; Neck; Parathyroid Neoplasms; Parathyroidectomy; Thyroidectomy
PubMed: 30702621
DOI: 10.1097/MD.0000000000014347 -
Asian Pacific Journal of Cancer... Dec 2017Objective: Ultrasonography (US) and parathyroid scintigraphy (PS) with 99mTc-MIBI are common methods for preoperative localization of parathyroid adenomas but there... (Comparative Study)
Comparative Study Meta-Analysis Review
Comparative Diagnostic Performance of Ultrasonography and 99mTc-Sestamibi Scintigraphy for Parathyroid Adenoma in Primary Hyperparathyroidism; Systematic Review and Meta- Analysis.
Objective: Ultrasonography (US) and parathyroid scintigraphy (PS) with 99mTc-MIBI are common methods for preoperative localization of parathyroid adenomas but there discrepancies exist with regard to diagnostic accuracy. The aim of the study was to compare PS and US for localization of parathyroid adenoma with a systematic review and meta-analysis of the literature. Methods: Pub Med, Scopus (EMbase), Web of Science and the reference lists of all included studies were searched up to 1st January 2016. The search strategy was according PICO characteristics. Heterogeneity between the studies was accounted by P < 0.1. Point estimates were pooled estimate of sensitivity, specificity and positive predictive value of SPECT and ultrasonography with 99% confidence intervals (CIs) by pooling available data. Data analysis was performed using Meta-DiSc software (version 1.4). Results: Among 188 studies and after deletion of duplicated studies (75), a total of 113 titles and abstracts were studied. From these, 12 studies were selected. The meta-analysis determined a pooled sensitivity for scintigraphy of 83% [99% confidence interval (CI) 96.358 -97.412] and for ultra-sonography of 80% [99% confidence interval (CI) 76-83]. Similar results for specificity were also obtained for both approache. Conclusion: According this meta- analysis, there were no significant differences between the two methods in terms of sensitivity and specificity. There were overlaps in 99% confidence intervals. Also features of the two methods are similar.
Topics: Humans; Hyperparathyroidism, Primary; Parathyroid Neoplasms; Prognosis; Radiopharmaceuticals; Technetium Tc 99m Sestamibi; Ultrasonography
PubMed: 29281866
DOI: 10.22034/APJCP.2017.18.12.3195