J Korean Endocr Soc.  2007 Aug;22(4):292-298. 10.3803/jkes.2007.22.4.292.

A Case of Primary Hyperparathyroidism due to Cystic Parathyroid Adenoma Presenting as Hypercalcemic Crisis Associated with Intracranial Hemorrhage

• Chung JO
• Jeong GH
• Hong SI
• Cho DH
• Chung DJ
• Chung MY

• KMID: 2063541
• DOI: http://doi.org/10.3803/jkes.2007.22.4.292

Abstract

Most patients with hypercalcemia are asymptomatic or they have non-specific symptoms at diagnosis. Yet hypercalcemic crisis is a potentially fatal complication of hyperparathyroidism. Cystic parathyroid adenoma is a rare cause of primary hyperparathyroidism and hypercalcemic crisis. A 52-year-old woman was transferred to our hospital due to her relapsed drowsy mental state and renal insufficiency that occurred in course of her management for intracranial hemorrhage with manitol. The total serum calcium was 16.2 mg/dL and the intact parathyroid hormone was 546 pg/mL. Neck computed tomography showed a 3.1 x 1.8 cm sized cystic mass on the right thyroid lower pole. 99mTc-labelled sestamibi scintigraphy showed no significant uptake. In addition to prompt saline infusion and loop diuretics, the patient was given pamidronate to lower the serum calcium, and she was improved to an alert mental state with normal renal function. Surgical excision of the parathyroid cyst was performed. A histological examination confirmed a cystic parathyroid adenoma. The levels of plasma PTH and serum calcium were normalized after resection.

Keyword

Hypercalcemia; Intracranial hemorrhage; Parathyroid adenoma

MeSH Terms

Calcium
Diagnosis
Female
Humans
Hypercalcemia
Hyperparathyroidism
Hyperparathyroidism, Primary*
Intracranial Hemorrhages*
Middle Aged
Neck
Parathyroid Hormone
Parathyroid Neoplasms*
Plasma
Radionuclide Imaging
Renal Insufficiency
Sodium Potassium Chloride Symporter Inhibitors
Thyroid Gland
Calcium
Parathyroid Hormone
Sodium Potassium Chloride Symporter Inhibitors

Figure

• 

  Fig. 1 Brain computed tomography showed intracranial hemorrhage in right basal ganglia with effacement of right lateral ventricle (A: on prior hospital visit). No significant interval change was evident (B: on our hospital visit).

• 

  Fig. 2 Neck ultrasonography showed about 2.69 × 2.31 × 3.85 cm sized hypoechoic and septated region in lower pole of right thyroid gland (A. transverse, B. longitudinal).

• 

  Fig. 3 Neck computed tomography revealed about 3.1 × 1.8 cm sized well defined heterogenous low attenuated mass lateral to right thyroid gland (A. non-enhanced, B. contrast enhanced).

• 

  Fig. 4 99mTc-sestamibi scintigraphy showed uneven faint MIBI uptake in lateral and inferior portion of right thyroid lobe after 15 minutes, but no significant MIBI accumulation after 120 minutes.

• 

  Fig. 5 Abdominal ultrasonography revealed tiny hyperechoic lesion with posterior acoustic shadowing (A). There is about 1.25 cm plate-like hyperechoic lesion in the right posterior wall of urinary bladder (B).

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  Fig. 6 Microscopic findings showed well-encapsulated mass circumscribed by a rim composed of compressed non-neoplastic parathyroid tissue and relatively thin fibrous connective tissue (A). PTH stain was positive (B). (A. H&E stain ×20, B. Immunohistochemical stain for PTH)

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