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European Archives of... Sep 2020Spontaneous neck hematoma is a rare yet potentially fatal complication of primary hyperparathyroidism (PHPT). Here we aim to describe novel presentations of neck...
PURPOSE
Spontaneous neck hematoma is a rare yet potentially fatal complication of primary hyperparathyroidism (PHPT). Here we aim to describe novel presentations of neck hematomas secondary to PHPT, discussing tools and signs that facilitate diagnosis.
METHODS
Case series data were extracted by retrospective chart reviews of our institution's electronic medical records, including all neck hematoma cases from parathyroid origin between 2005 and 2020. Cases from PubMed and EMBASE between 1999 and 2020 were analyzed in a systematic literature review.
RESULTS
Four patients were identified with five acute bleeding events, including a novel report of recurrent neck hemorrhage due to parathyroid adenoma. There was postmenopausal female predominance (75%), consistent with previous reports (72.7%). Common presentations included neck pain, dysphagia and hoarseness. All bleedings spread into the retropharyngeal space. Vocal cord paralysis was found in a single case and in 8.6% of the benign lesions in the reviewed cases. A single case presented with normal calcium levels (20% of bleeding episodes), in line with the reviewed cases (17.4%). A subtle CT sign of an enhancing area within the parathyroid gland, which led to the diagnosis, was identified in a single case. Conservative treatments were employed in 80% of our cases and in 51.5% of the reviewed cases, all being successful. Neck explorations performed after a 3-month waiting period from the acute event demonstrated better results compared to immediate surgery.
CONCLUSION
A high suspicion index is needed, particularly in post-menopausal women, to reach a diagnosis and allow optimal management. Normal laboratory values do not exclude parathyroid etiology, yet assessment should include calcium and PTH levels along with targeted imaging. Since bleeding may recur, we suggest that PHPT complicated with neck hematoma should be an independent indication for definitive parathyroidectomy surgery.
LEVEL OF EVIDENCE
3b.
Topics: Adenoma; Female; Hematoma; Humans; Neck; Neoplasm Recurrence, Local; Parathyroid Glands; Parathyroid Hormone; Parathyroid Neoplasms; Parathyroidectomy; Retrospective Studies
PubMed: 32279105
DOI: 10.1007/s00405-020-05959-z -
The American Journal of Medicine May 2021
Topics: Adenoma; Aged; Anemia; Diagnosis, Differential; Humans; Hypercalcemia; Male; Multiple Myeloma; Osteoporotic Fractures; Parathyroid Neoplasms; Renal Insufficiency
PubMed: 33245923
DOI: 10.1016/j.amjmed.2020.10.030 -
Frontiers in Endocrinology 2022Primary hyperparathyroidism (PHPT) is the most prevalent cause of hypercalcemia, affecting 0.3% of the population. The only curative procedure is parathyroidectomy....
Primary hyperparathyroidism (PHPT) is the most prevalent cause of hypercalcemia, affecting 0.3% of the population. The only curative procedure is parathyroidectomy. Persistent PHPT occurs in 4.7 percent of patients, even in the most skilled hands. Ectopic adenomas are challenging to localize before and during surgery and frequently result in persistent PHPT. We presented a case with persistent PHPT due to lung parathyroid adenoma that was successfully resected with video-assisted thoracoscopic surgery. A 55-year-old female patient was admitted to our endocrinology clinic with persistent PHPT after four neck explorations over 16 years. The last m Tc-MIBI scintigraphy with SPECT showed nothing suggestive of parathyroid adenoma, neither in the neck nor the mediastinum, but a solitary nodule as an incidental finding was reported in the lower lobe of the right lung, which was highly probable for a parathyroid adenoma in a fluorodeoxyglucose PET scan. Pathological examination ruled out parathyromatosis and lung malignancy; despite its location outside the anticipated embryonic pathway, pathology revealed the presence of an ectopic parathyroid adenoma. After the surgery, serum parathyroid hormone and calcium levels decreased, and hypoparathyroidism was corrected with calcium carbonate and calcitriol.
Topics: Female; Humans; Middle Aged; Parathyroid Neoplasms; Hyperparathyroidism; Parathyroid Glands; Technetium Tc 99m Sestamibi; Adenoma; Lung
PubMed: 36583007
DOI: 10.3389/fendo.2022.988035 -
Thyroid : Official Journal of the... Aug 2007
Topics: Adenoma; Adult; Female; Humans; Parathyroid Glands; Parathyroid Neoplasms; Tomography, Emission-Computed, Single-Photon
PubMed: 17725439
DOI: 10.1089/thy.2006.0301 -
An Ectopic Parathyroid Adenoma Mimicking Submandibular Gland on 99mTc-MIBI Parathyroid Scintigraphy.Clinical Nuclear Medicine Oct 2022A 67-year-old woman complained of continuous low back pain for 4 months. She was referred for a 99mTc-MIBI parathyroid scintigraphy with neck SPECT/CT imaging. The...
A 67-year-old woman complained of continuous low back pain for 4 months. She was referred for a 99mTc-MIBI parathyroid scintigraphy with neck SPECT/CT imaging. The planar images showed no abnormal uptake. However, on the SPECT/CT scan, a soft tissue nodule with high uptake was noted adjacent to the left submandibular gland, mimicking normal submandibular gland uptake. Pathological examination from surgical specimen showed that it was an ectopic parathyroid adenoma.
Topics: Adenoma; Aged; Female; Humans; Parathyroid Glands; Parathyroid Neoplasms; Radionuclide Imaging; Submandibular Gland; Technetium Tc 99m Sestamibi
PubMed: 36067087
DOI: 10.1097/RLU.0000000000004277 -
Updates in Surgery Apr 2024Primary hyperparathyroidism (PHPT) is an endocrinological disease that affects systemic inflammation. This study is aimed to investigate the preoperative and...
Primary hyperparathyroidism (PHPT) is an endocrinological disease that affects systemic inflammation. This study is aimed to investigate the preoperative and postoperative effect of PHPT on systemic inflammation. A total of 203 patients who were successfully operated for PHPT and 98 healthy controls were included in the study. The blood tests of the patients in the last month preoperatively and in the postoperative 6th month were compared. In addition, preoperative and postoperative tests were compared with the healthy control group. When the preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and systemic inflammation index (SII) values of the patients who were operated for parathyroid adenoma were compared with the control group (p values were < 0.05, 0.01, 0.19, < 0.05), the NLR, PLR, and SII values were significantly lower in the patient group with parathyroid adenoma than in the control group. When the preoperative and postoperative 6th month NLR, PLR, LMR, and SII values of the patients were compared (p values: 0.026, 0.56, 0.023, 0.016, respectively), there was a significant increase in NLR and SII values after excision, while a significant decrease was observed in the LMR value. When the postoperative 6th month NLR, PLR, LMR, SII values were compared with the healthy control group (p values: 0.22, 0.29, 0.19, 0.29, respectively), no significant difference was observed between all values. We found that the immune system was suppressed in PHPT and this returned to normal levels after a successful surgery.
Topics: Humans; Parathyroid Neoplasms; Retrospective Studies; Lymphocytes; Blood Platelets; Inflammation
PubMed: 38104303
DOI: 10.1007/s13304-023-01734-x -
Japanese Journal of Clinical Oncology Mar 2004A 45-year-old female patient was admitted to our hospital presenting with a right anterior cervical tumor that was elastic, hard, painless and 3.5 x 3.5 cm in size....
A 45-year-old female patient was admitted to our hospital presenting with a right anterior cervical tumor that was elastic, hard, painless and 3.5 x 3.5 cm in size. Laboratory data including serum calcium level, thyroid and parathyroid hormonal functions revealed no abnormalities. Further examination, consisting of computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography (US) and radioisotope (RI)-imaging demonstrated that it was a solid tumor located behind the right thyroid lobe. The tumor, whose origin was unclear, was successfully removed with right thyroid lobectomy. Macroscopically, it appeared as reddish solid tumor consisting of small cystic lesions storing chocolate-colored mucous. Immunohistology confirmed that there was proliferation of chief cells with positive parathyroid hormone (PTH) staining. Thus the tumor was diagnosed as parathyroid adenoma despite a lack of clinical evidence for hyperparathyroidism. The reason for the lack of clinical features of hyperparathyroidism in this adenoma still remains unclear, however, there might be inactivation of hormone excretion, possibly due to insufficiency of blood supply. This was a very rare case of parathyroid adenoma exhibiting no clinical evidence of hyperparathyroidism.
Topics: Adenoma; Female; Humans; Hyperparathyroidism; Magnetic Resonance Imaging; Middle Aged; Neck; Parathyroid Hormone; Parathyroid Neoplasms; Tomography, X-Ray Computed; Ultrasonography
PubMed: 15078912
DOI: 10.1093/jjco/hyh028 -
Journal of Ayub Medical College,... 2006Parathyroid carcinoma is a very rare cause of primary hyperparathyroidism and these tumors are usually hyper-functioning as compared to other malignant endocrine tumors....
Parathyroid carcinoma is a very rare cause of primary hyperparathyroidism and these tumors are usually hyper-functioning as compared to other malignant endocrine tumors. Surgery is the only effective primary treatment. We report a patient, who presented with pathological fracture of femur, hypercalcemia, bilateral renal stones, markedly raised Parathormone levels and palpable mass in the neck. Parathyroid adenoma was initially diagnosed and localized at left lower gland by Sestamibi scan and ultrasonography. She underwent surgery and enlarged parathyroid gland was removed. Intra operatively there was no evidence of local invasion or lymph nodes involvement but biopsy report suggested malignancy.
Topics: Adenoma; Diagnosis, Differential; Female; Humans; Middle Aged; Parathyroid Neoplasms
PubMed: 16977824
DOI: No ID Found -
Journal Belge de Radiologie 1988
Topics: Adenoma; Aged; Humans; Hyperparathyroidism; Male; Parathyroid Neoplasms; Radionuclide Imaging; Tomography, X-Ray Computed; Ultrasonography
PubMed: 3072340
DOI: No ID Found -
The Japanese Journal of Thoracic and... Sep 2002We report a case of spontaneous parathyroid adenoma hemorrhage. A 50-year-old man with a sore throat, and swelling and ecchymosis of the entire anterior neck was found...
We report a case of spontaneous parathyroid adenoma hemorrhage. A 50-year-old man with a sore throat, and swelling and ecchymosis of the entire anterior neck was found in cervical and chest computed tomography revealed to have a low-density area extending from the parapharyngeal region to below the carina, Suspecting descending necrotizing mediastinitis secondary to a peritonsillar abscess, we conducted mediastinal and cervical drainage, but found no abscess. No evidence was found, either, in bacteriological culture of sputum and pleural effusion. After the hematoma disappeared, cervical ultrasonography indicated parathyroid adenoma. Serum calcium was marginally increased, indicating that serum calcium should be determined if cervical or mediastinal hematoma develops without an obvious cause.
Topics: Adenoma; Calcium; Hematoma; Hemorrhage; Humans; Male; Mediastinal Diseases; Middle Aged; Parathyroid Neoplasms
PubMed: 12382409
DOI: 10.1007/BF02913192