Ann Surg Treat Res.  2016 Sep;91(3):145-148. 10.4174/astr.2016.91.3.145.

Recurrent hyperparathyroidism due to proliferation of autotransplanted parathyroid tissue in a multiple endocrine neoplasia type 2A patient

• Kim BK
• Lee J
• Sun WY

• KMID: 2350542
• DOI: http://doi.org/10.4174/astr.2016.91.3.145

Abstract

About 20%-30% of all cases of multiple endocrine neoplasia type 2A (MEN 2A) is accompanied by primary hyperparathyroidism. These patients undergo parathyroidectomy and, if needed, autotransplantation. In rare cases, autotransplanted parathyroid tissues can cause hypoparathyroidism due to failure of transplantation or hyperparathyroidism due to proliferation of the transplanted tissue. A 68-year-old female with MEN 2A underwent left adrenalectomy for pheochromocytoma 15 years prior to presentation and total thyroidectomy, central and right lateral neck lymph node dissection, and subtotal parathyroidectomy with autotransplantation for medullary thyroid cancer and primary hyperparathyroidism 6 years previous. Recently, a doubtful parathyroid adenoma was detected in the left sternocleidomastoid muscle on ultrasonography and on an additional sestamibi scan. The mass was excised and histologically confirmed as parathyroid adenoma. This is a very rare case, and it suggests that long-term regular monitoring of serum calcium and intact parathyroid hormone levels is necessary after parathyroid autotransplantation.

Keyword

Multiple endocrine neoplasia type 2A; Parathyroid glands; Autologous transplantation; Recurrence

MeSH Terms

Adrenalectomy
Aged
Autografts
Calcium
Female
Humans
Hyperparathyroidism*
Hyperparathyroidism, Primary
Hypoparathyroidism
Lymph Node Excision
Multiple Endocrine Neoplasia Type 2a*
Multiple Endocrine Neoplasia*
Neck
Parathyroid Glands
Parathyroid Hormone
Parathyroid Neoplasms
Parathyroidectomy
Pheochromocytoma
Recurrence
Thyroid Neoplasms
Thyroidectomy
Transplantation, Autologous
Ultrasonography
Calcium
Parathyroid Hormone

Figure

• 

  Fig. 1 The patient's familial diagram. The patient (black arrow) and her siblings had all undergone thyroidectomy (filled with gray). Some of her siblings were diagnosed with medullary thyroid cancer.

• 

  Fig. 2 Ultrasonographic image of a 68-year-old female with recurrent hyperparathyroidism. (A) A 1.3 cm × 0.6 cm round hypoechoic nodule in the left sternocleidomastoid muscle. (B) The nodule was well supplied with vessels according to Doppler flow mode.

• 

  Fig. 3 A sestamibi scan. (A) 10 minutes, (B) 2 hours, and (C) 3 hours after administration, focal hot uptake was observed.

• 

  Fig. 4 (A) Parathyroid adenoma excision. A transplanted parathyroid adenoma in the sternal part of the left sternocleidomastoid muscle. (B) An excised parathyroid adenoma consisting of a 1.6-cm ovoid mass.

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