Chonnam Med J.  2013 Dec;49(3):125-128. 10.4068/cmj.2013.49.3.125.

Parathyroid Cyst Presenting as Acute Pancreatitis: Report of a Case

• Kim MY
• Chung CY
• Kim JS
• Myung DS
• Cho SB
• Park CH
• Kim Y
• Joo YE

• KMID: 2048817
• DOI: http://doi.org/10.4068/cmj.2013.49.3.125

Abstract

We report the first case of hypercalcemia-induced acute pancreatitis caused by a functioning parathyroid cyst in a 67-year-old man. Laboratory investigation revealed increased serum amylase and lipase, increased serum ionized calcium and parathyroid hormone (PTH) levels, and decreased serum phosphate, indicating pancreatitis and primary hyperparathyroidism (PHPT). Abdominal computed tomography (CT) revealed mild swelling of the pancreatic head with peri-pancreatic fat infiltration and fluid collection around the pancreatic tail. Ultrasonography and CT of the neck showed a cystic lesion at the inferior portion of the left thyroid gland, suggesting a parathyroid cyst. There was no evidence of parathyroid adenoma by 99mTc sestamibi scintigraphy. PHPT caused by a functioning parathyroid cyst was suspected. The patient underwent surgical resection of the functioning parathyroid cyst owing to his prolonged hypercalcemia. At 3 weeks after the operation, his serum levels of PTH, total calcium, ionized calcium, inorganic phosphate, amylase, and lipase were normalized. At the follow-up examinations, he has remained asymptomatic.

Keyword

Pancreatitis; Hyperparathyroidism, Primary; Cysts

MeSH Terms

Aged
Amylases
Calcium
Follow-Up Studies
Head
Humans
Hypercalcemia
Hyperparathyroidism, Primary
Lipase
Neck
Pancreatitis*
Parathyroid Hormone
Parathyroid Neoplasms
Radionuclide Imaging
Technetium Tc 99m Sestamibi
Thyroid Gland
Ultrasonography
Amylases
Calcium
Lipase
Parathyroid Hormone
Technetium Tc 99m Sestamibi

Figure

• 

  FIG. 1 Abdominal computed tomography (A, B) showed mild swelling of the pancreatic head with peri-pancreatic fat infiltration (arrow head) and fluid collection around the pancreatic tail (arrow).

• 

  FIG. 2 Neck ultrasonography revealed a left infrathyroidal cystic lesion (A). Neck computed tomography revealed an approximately 5.4-cm sized low attenuated lesion (arrow) in the left the infrathyroidal area extending to the mediastinum (B).

• 

  FIG. 3 Histopathological examination of the cyst revealed no epithelial lining and a cystic wall composed of fibrous tissue (hematoxylin&eosin stain, ×12.5) (A), (H&E stain, ×40) (B). Focal parathyroid hyperplasia along the luminal side of the cyst wall was positive for parathyroid hormone (PTH stain, ×40) (C).

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