J Korean Endocr Soc.  2007 Dec;22(6):470-474. 10.3803/jkes.2007.22.6.470.

A Case of Primary Hyperparathyroidism Associated with Gall-bladder Stone and Chronic Cholecystitis

• Lee JH
• Jung PM
• Kim CW
• Shin MS
• Park HJ
• Nam SM
• Lee MY
• Koh JH
• Cho MY
• Shin JY
• Chung CH
• Shin YG

• KMID: 1958914
• DOI: http://doi.org/10.3803/jkes.2007.22.6.470

Abstract

Primary hyperparathyroidism is caused mainly by a parathyroid adenoma or hyperplasia, and is characterized by hypercalcemia and hypophosphatemia induced by an increased level of parathyroid hormone (PTH). Patients with primary hyperparathyroidism are usually asymptomatic and the disease is most often detected incidentally. However, patients can present with symptoms of renal stones, peptic ulcer disease, muscle weakness, depression, constipation, and pancreatitis. In addition, it has been reported that choletithiasis can be combined with primary hyperparathyroidism. We report a case of a 49-year-old man with primary hyperparathyroidism accompanied with chronic cholecystitis caused by a gallbladder (GB) stone. The chief complaint was nausea, poor oral intake, abdominal pain, and weight loss. Abdominal sonography was performed and chronic cholecystitis with a GB stone was diagnosed. The serum calcium level was 18.5 mg/dL and the intact parathyroid hormone level was 1,777 pg/mL. A parathyroid mass was detected by neck-computed tomography, neck ultrasonography and a (99m)Tc-Tetrofosmin parathyroid scan. The parathyroid mass was removed and the mass was confirmed as a parathyroid adenoma. Cholecystectomy was performed and the diagnosis of chronic cholecystitis was confirmed. After the surgical procedure, the symptoms improved and the calcium level was normalized.

Keyword

cholelithiasis; chronic cholecystitis; hypercalcemia; primary hyperparathyroidism

MeSH Terms

Abdominal Pain
Calcium
Cholecystectomy
Cholecystitis*
Cholelithiasis
Constipation
Depression
Diagnosis
Gallbladder
Humans
Hypercalcemia
Hyperparathyroidism, Primary*
Hyperplasia
Hypophosphatemia
Middle Aged
Muscle Weakness
Nausea
Neck
Pancreatitis
Parathyroid Hormone
Parathyroid Neoplasms
Peptic Ulcer
Ultrasonography
Weight Loss
Calcium
Parathyroid Hormone

Figure

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  Fig. 1 Abdominal ultrasonographic shows multiple small gallbladder stones. The gallbladder wall was irregular and diffusely thickened margin. But, there was no fluid collection around gall-bladder.

• 

  Fig. 2 Neck ultrasonographic (A) and computed tomographic findings (B). About 2 × 2 × 3 cm sized heterogenous hypoechoic nodule associated with cystic change was seen in right thyroid lobe at ultrasonography. The similar finding is seen in neck computed tomography.

• 

  Fig. 3 The finding of 99mTc-parathyroid scan. After injection of Tc-99m Tetrofosmin 20 mCi, the two phase study was done at 20 minutes and 2 hours. There is minimal uptake in right parathyroid gland.

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  Fig. 4 Pathologic findings of parathyroid gland and gallbladder. In Fig. 4-1, gross finding of removed parathyroid gland tumor is seen. The surface of parathyroid gland tumor shows white and gray colored homogeneous myxoid appearance with central cystic change. Fig. 4-2 and 4-3 shows the microscopic findings. In the low power field view (HE ×100), the cellular chief cells proliferation (P) has a nest and solid growth pattern with a capsular zone (C) containing remnants of normal parathyroid glands (N). In the high power field view (HE ×400), the chief cells have relatively regular small round hyperchromatic nuclei with abundant light cytoplasm. These findings suggest that the parathyroid mass is diagnosed as parathyroid adenoma. In Fig. 4-4, pathologic findings of gallbaldder could be seen. Several black pigment stones are found in the resected gallbladder (A). The microscopic examination of gallbladder shows dilated Rokitansky-Aschoff sinuses filled with bile without significant inflammation (B) (H&E ×40). These findings indicate the gallbladder stone and chronic cholecystitis.

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