J Korean Soc Endocrinol.  2005 Jun;20(3):278-282. 10.3803/jkes.2005.20.3.278.

A Case of Primary Hyperparathyroidism Caused by Cystic Parathyroid Adenoma, Diagnosed during Intra-Operative PTH Monitoring

• Yoo HJ
• Kim NH
• Park SY
• Kim DJ
• Yang SJ
• Park JR
• Kim HY
• Seo JA
• Lee KW
• Kim SG
• Choi KM
• Lee JB
• Lee YS
• Baik SH
• Choi DS

• KMID: 2200569
• DOI: http://doi.org/10.3803/jkes.2005.20.3.278

Abstract

Primary hyperparathyroidism is the most frequent cause of hypercalcemia, and its prevalence is increasing due to the routine examination of serum calcium levels. Primary hyperparathyroidims is most commonly caused by an adenoma or hyperplasia of the parathyroid gland. A cystic parathyroid adenoma is an extremely rare cause of primary hyperparathyroidism. In our case, a-79-year old female presented with lower back pain and constipation. Her serum calcium, phosphate and immunoreactive parathyroid homone levels were 15.6, 1.8mg/dL and 371.8pg/mL, respectively. Neck CT revealed a cystic mass and a contour bulging heterogeneous mass in the left inferior right thyroid gland, respectively. These mass lesions were removed, and the intra-operative parathyroid hormone levels monitored, to confirm the complete resection. After removing the left cystic mass to the inferior thyroid, the serum calcium and immunoreactive parathyroid hormone levels quickly returned to normal. We report a case of primary hyperparathyroidism, caused by a cystic parathyroid adenoma, with a brief review of the literature

MeSH Terms

Adenoma
Calcium
Constipation
Female
Humans
Hypercalcemia
Hyperparathyroidism
Hyperparathyroidism, Primary*
Hyperplasia
Low Back Pain
Neck
Parathyroid Glands
Parathyroid Hormone
Parathyroid Neoplasms*
Prevalence
Thyroid Gland
Calcium
Parathyroid Hormone

Figure

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  Fig. 1 Neck sonogram shows complicated cystic mass in the inferior pole of the left thyroid gland and heterogenous, slightly echogenic mass in the inferior pole of the right thyroid gland.

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  Fig. 2 Neck CT scan shows 3×2×1.5 cm cystic mass in the inferior pole of the left thyroid gland, contour bulging mass in the inferior pole of the right thyroid gland and multiple tiny cysts in both thyroid glands.

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  Fig. 3 Tc99m-Sestamibi scan shows no increased abnormal radioactivity after 90min delayed image.

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  Fig. 4 We removed cystic mass in the inferior pole of the left thyroid gland

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  Fig. 5 The pathologic finding of left cystic mass is appropriate to parathyroid cystic adenoma. It is composed of chief cell (H&E ×100)

Reference

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