scholarly journals SAT-349 Cinacalcet Resistant Tertiary Hyperparathyroidism with One Large Parathyroid Gland

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Bayan Chaker ◽  
Hussam Alim ◽  
Wael Taha
Keyword(s):  
Hospital Stay ◽  
Parathyroid Adenoma ◽  
Parathyroid Gland ◽  
Calcium Level ◽  
Parathyroid Glands ◽  
Incomplete Resection ◽  
Lower Pole ◽  
Tertiary Hyperparathyroidism ◽  
The Right ◽  
Inferior Parathyroid Gland

Abstract Tertiary hyperparathyroidism is thought to develop after long term secondary hyperparathyroidism, such as CKD on dialysis. In This case, all parathyroid glands are significantly enlarged. We report a case of an 84-year-old female with a past medical history of ESRD on HD and recurrent nephrolithiasis who was found to have an enlarged multinodular goiter with the dominant mass in the lower pole of the right gland measuring about 4.7 cm on thyroid ultrasound. Blood work was done which showed elevated intact PTH levels at 2720 pg/mL (12–88). Her calcium level was normal at that time at 10.5 mg/dL (8.6–10.8) with an albumin of 4.2 g/dL (3.5–5.7), and a phosphorus of 5.7 mg/dL (2.5–4.5). Patient had a DEXA scan which showed severe osteoporosis in the lumbar spine, left hip, and right forearm. Patient had increased PTH levels despite being on Cinacalcet. She had a nuclear medicine parathyroid scan with SPECT CT which showed increased uptake along the right inferior thyroid concerning for a large right lower parathyroid adenoma or functional thyroid nodule. FNA of the nodule was done and showed colloid nodule but PTH wash showed elevated PTH at 7634 pg/mL. She was referred for right lower parathyroidectomy and Cinacalcet was discontinued prior to surgery. She had right and left inferior parathyroidectomy and 4 gland exploration. Pathology showed the right inferior parathyroid gland to be markedly hyper-cellular, weighing 36 grams consistent with hyperplasia and the left inferior parathyroid gland to be slightly hyper-cellular parathyroid gland consistent with hyperplasia. No evidence of malignancy was noted on pathology. Prior to surgery her calcium level of 10.6 mg/dL which went down to 9.6 mg/dL post-operatively. Patient then developed severe hypocalcemia and hungry bone syndrome following the surgery requiring a calcium drip for 3 days post-operatively. Was changed to oral calcium but required large amounts of calcium gluconate and calcitriol supplementation and an extended hospital stay of 13 days. However, throughout the hospital stay, PTH levels continued trending back up to 239 which may represent either increased activity from remaining parathyroid glands or residual parathyroid adenoma with incomplete resection. Post-operative US neck showed Post-surgical collection in the lower pole of the right gland measuring 4.8 cm compatible with recent resection. In conclusion, tertiary hyperparathyroidism can develop due to one enlarged parathyroid gland or an adenoma, which can be resistant to cinacalcet.

Roy Mac Clare. Secondary insufficiency of the parathyroid glands after removal of the parathyroid adenoma and the ineffectiveness of treatment with extracts of the parathyroid glands. (Arch. Of Surgery, vol. 33, no. 5, 1936)

1937 ◽  
Vol 33 (12) ◽  
pp. 1506-1507
Author(s):  
Е. Auslander
Keyword(s):  
Thyroid Gland ◽  
Parathyroid Adenoma ◽  
Parathyroid Gland ◽  
Parathyroid Glands ◽  
Lower Pole ◽  
Right Lobe ◽  
The Right

A 51-year-old woman underwent surgery to remove the parathyroid glands for fibrocystic osteitis with spontaneous fractures. A tumor of the parathyroid gland was found adjacent to the lower pole of the right lobe of the thyroid gland, as a result of which the entire right lobe was removed.

ERRATUM

2011 ◽  
Vol 135 (12) ◽  
pp. 1521-1521
Keyword(s):  
Parathyroid Adenoma ◽  
Parathyroid Gland ◽  
Cutaneous Melanoma ◽  
Rare Case ◽  
Tumor Metastasis ◽  
Arch Pathol ◽  
Tumor To Tumor Metastasis ◽  
The Right ◽  
Inferior Parathyroid Gland ◽  
Incorrect Data

An abstract published in the September 2011 issue of the Archives (Murugan P et al. Tumor-to-Tumor Metastasis: A Rare Case of Cutaneous Melanoma Metastatic to a Parathyroid Adenoma [CAP abstract 109, session 100]. Arch Pathol Lab Med. 2011;135[9]:1132) contains incorrect data in line 10 when referring to the right inferior parathyroid gland that was removed. The weight of the gland should have been shown as “…1200-mg (normal, 30–70 mg)…”

Paraganglioma: an unusual tumour of the parathyroid gland

1996 ◽  
Vol 110 (2) ◽  
pp. 196-199 ◽  
Author(s):  
W. G. McCluggage ◽  
C. H. S. Cameron ◽  
D. Brooker ◽  
M. D. O'Hara
Keyword(s):  
Electron Microscopy ◽  
Differential Diagnosis ◽  
Parathyroid Adenoma ◽  
Parathyroid Gland ◽  
Incidental Finding ◽  
Squamous Carcinoma ◽  
Pathological Features ◽  
Unusual Variant ◽  
The Right ◽  
Inferior Parathyroid Gland

AbstractA case of paraganglioma arising within a parathyroid gland is reported. The lesion was an incidental finding in a block dissection of neck performed for squamous carcinoma of the pharynx. A well-circumscribed lesion, exhibiting the characteristic pathological features of a paraganglioma, was embedded within the right inferior parathyroid gland. Due to its location, the chief histological differential diagnosis was an unusual variant of parathyroid adenoma. Immunohistochemistry and electron microscopy assisted in reaching a diagnosis. This, as far as we are aware, is the first reported case of a paraganglioma of the parathyroid gland.

Parathyroid Cancer in a Hemodialysis Patient: A Case Report

2002 ◽  
Vol 88 (5) ◽  
pp. 430-432 ◽  
Author(s):  
Vladan Zivaljevic ◽  
Ksenija Krgovic ◽  
Svetislav Tatic ◽  
Marija Havelka ◽  
Zora Dimitrijevic ◽  
...  
Keyword(s):  
Parathyroid Gland ◽  
Hemodialysis Patient ◽  
Rare Condition ◽  
Parathyroid Glands ◽  
The Other ◽  
Parathyroid Cancer ◽  
En Bloc ◽  
Subtotal Parathyroidectomy ◽  
The Right ◽  
Inferior Parathyroid Gland

An extremely rare case of parathyroid cancer in a hemodialysis patient is presented here. A 69-year-old man was operated on for secondary hyperparathyroidism due to chronic renal failure. A locally invasive tumor of the right inferior parathyroid gland and enlargement of the other three parathyroid glands were found during bilateral neck exploration. Surgical management consisted of en bloc resection of the right inferior parathyroid gland with the right thyroid lobe and part of a sternothyroid muscle along with subtotal parathyroidectomy of the three enlarged parathyroid glands. Histological examination of the resected tumor provided evidence of a parathyroid cancer in the right inferior parathyroid gland. Nodular hyperplasia was confirmed histologically in the other three glands. With less than 20 previous cases described in the literature, parathyroid cancer is a very rare condition in hemodialysis patients.

scholarly journals Parathyroid Carcinoma in the Setting of Tertiary Hyperparathyroidism: Case Report and Review of the Literature

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Federico Cappellacci ◽  
Fabio Medas ◽  
Gian Luigi Canu ◽  
Maria Letizia Lai ◽  
Giovanni Conzo ◽  
...  
Keyword(s):  
Parathyroid Gland ◽  
Parathyroid Carcinoma ◽  
Histopathological Examination ◽  
Normal Population ◽  
Survival Rates ◽  
Horseshoe Kidney ◽  
Cervical Region ◽  
Tertiary Hyperparathyroidism ◽  
The Right ◽  
Inferior Parathyroid Gland

Introduction. Parathyroid carcinoma is one of the rarest cancers in normal population, and it is extremely uncommon in the setting of tertiary hyperparathyroidism. Indeed, only 24 cases have been reported in the literature. Presentation of the Case. We report the case of parathyroid carcinoma in a 51-year-old man, with a history of end-stage renal disease due to a horseshoe kidney treated with haemodialysis since 2013. He came to our attention due to an increase in calcium and parathyroid hormone serum levels. Neck ultrasound (US) showed a solid hypodense mass, probably the right inferior parathyroid gland, with an estimated size of 25 × 15 × 13 mm; the 99mTc-sestamibi SPECT/CT scan revealed a large radiotracer activity area in the right cervical region, compatible with a hyperfunctioning right inferior parathyroid gland. So, a tertiary hyperparathyroidism diagnosis was made. In April 2018, resection of three parathyroid glands was performed. Histopathological examination demonstrated the right inferior parathyroid gland specimen to be a parathyroid carcinoma, due to the presence of multiple, full-thickness, capsular infiltration foci, and a venous vascular invasion focus. Discussion. Diagnosis of parathyroid carcinoma in tertiary hyperparathyroidism is remarkably complex because of the lack of clinical diagnostic criteria and, in many cases, is made postoperatively at histopathological examination. Conclusion. To date, radical surgery represents the mainstay of treatment, with a five- and ten-year survival rates overall acceptable.

scholarly journals Primary Hyperparathyroidism due to Parathyroid Adenoma Originated from Supernumerary Gland

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Fernando Mendoza-Moreno ◽  
Ángel Rodriguez-Pascual ◽  
María Rocío Díez-Gago ◽  
Marina Pérez-González ◽  
Laura Jiménez‐Alvárez ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Parathyroid Gland ◽  
Imaging Techniques ◽  
High Sensitivity ◽  
Parathyroid Glands ◽  
Parathyroid Surgery ◽  
Thyroid Lobe ◽  
The Impact ◽  
Supernumerary Gland

Introduction. The variability of the location of the parathyroid glands is directly related to the events that occur during embryonic development. The impact that an individual submits more than four parathyroid glands is close to 13%. However the presentation of a parathyroid adenoma in a supernumerary gland is an uncommon event. Case report. A 30-year-old man diagnosed with primary hyperparathyroidism with matching findings on ultrasonography and scintigraphy for parathyroid adenoma localization lower left regarding the thyroid gland. A cervicotomy explorer showed four orthotopic parathyroid glands. The biopsy of the inferior left gland was normal. No signs of adenoma were seen in the biopsy. Following mobilization of the ipsilateral thyroid lobe, fifth parathyroid gland was found increased significantly in size than proceeded to remove, confirming the diagnosis of adenoma. After the excision, the levels of serum calcium and parathyroid hormone were normalized. Conclusions. The presentation of a parathyroid adenoma in a supernumerary gland is a challenge for the surgeon. The high sensitivity having different imaging techniques has been a key to locate preoperatively the pathological parathyroid gland. Analytical or clinical persistence of primary hyperparathyroidism after parathyroid surgery can occur if the location of the adenoma is a supernumerary or ectopic gland location.

scholarly journals Rare Case of Severe Hypercalcemia Secondary to Atypical Sestamibi Negative Parathyroid Cystic Adenoma

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A266-A267
Author(s):  
Timur Gusov ◽  
John Chen Liu ◽  
Sowjanya Naha ◽  
F N U Marium ◽  
Joseph Theressa Nehu Parimi ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Parathyroid Gland ◽  
Severe Hypercalcemia ◽  
Parathyroid Adenomas ◽  
Sestamibi Scan ◽  
Serum Pth ◽  
The Right ◽  
99Mtc Sestamibi ◽  
Cystic Adenoma

Abstract Primary hyperparathyroidism (PHPT) is defined as excessive secretion of parathyroid hormone (PTH) originating from the parathyroid gland. The most common cause is a single parathyroid adenoma which is typically solid. Cystic parathyroid adenomas (CPA) are the cause of about 1–2% of cases of primary hyperparathyroidism. It is known that cystic parathyroid adenomas are a result of degeneration of an existing parathyroid adenoma. SestaMIBI is an imaging study based on uptake of radioactive technetium99 and used to localize parathyroid adenomas. We describe an unusual case of severe hypercalcemia secondary to 99mTc sestaMIBI negative atypical parathyroid cystic adenoma. A 56-year-old male presented to our facility with nausea and vomiting. His past medical history included hypertension and hepatitis C with no history of fractures or kidney disease. Physical examination was normal. Upon admission the patient was afebrile with blood pressure of 170/120 mmHg and heart rate of 62 bpm. Chemistry showed Calcium of 14.5 mg/dL (8.6–10.2mg/dL), phosphorus 2.2 (2.7–4.5) mh/dL, magnesium 1.8 (1.7–2.6)mg/dL, intact PTH of 375 (15–65) pg/mL, PTH-related peptide <2.0 pmol/L(<2 pmol/L), 25-OH vitamin D of 19 ng/ml (30–80), Creatinine 1.22 (0.7–1.2)mg/dL, alkaline phosphatase 95 (40–129) units/L. He was started on aggressive hydration, calcitonin 4 units/kg, 4 mg of IV Zolendroninc acid. Neck sonogram revealed a large, complex, predominantly anechoic lesion with solid vascular components and thick internal septations in the inferior and medial aspect of the right thyroid lobe measuring 3 x 2 x 5.5 cm. Findings were confirmed with CT of the neck. Since Sestamibi scan (planar and SPECT/CT) did not show uptake in parathyroid glands, the cyst was thought to be of thyroid origin. Fine needle aspiration was not able to detect cellular material, but PTH was >100 pg/ml on the FNA sample. Otolaryngology service was consulted for parathyroidectomy. During the surgical treatment, the right upper parathyroid gland was removed with no changes in serum PTH. Next, the cystic lesion was removed with normalization of serum PTH (from 218 pg/ml to 35.2 pg/ml respectively). Intraoperative frozen section analysis was read as a cystic parathyroid adenoma. The final pathology report revealed cystic parathyroid tissue favoring parathyroid adenoma with focal atypia. Hypercalcemia resolved. Conclusions: Atypical cystic parathyroid adenomas are a rare cause of PHPT. 90% of parathyroid cysts are nonfunctional. Above mention is a case of a patient presenting with hypercalcemic crisis secondary to cystic parathyroid adenoma, which posed a diagnostic challenge as both neck ultrasound and 99mTc sestaMIBI scan were inconclusive. These findings should trigger suspicion for functional parathyroid lesions. Cystic components should be evaluated for PTH levels and if significantly elevated should be treated as a parathyroid adenoma.

scholarly journals Different Shapes of the Human Parathyroid Glands – A Postmortem Study

1970 ◽  
Vol 18 (1) ◽  
pp. 44-46 ◽  
Author(s):  
S Mahbub ◽  
S Ara ◽  
A Alim ◽  
ASM Nurunnabi ◽  
R Ahmed ◽  
...  
Keyword(s):  
Parathyroid Adenoma ◽  
Key Words ◽  
Parathyroid Gland ◽  
Forensic Medicine ◽  
Descriptive Study ◽  
Parathyroid Glands ◽  
Post Mortem ◽  
Medical College ◽  
Different Shapes ◽  
Clinical Conditions

Context: The parathyroid glands are very essential for survival. Parathyroid related clinical conditions such as parathyroid adenoma and hyperplasia are common. Different shapes of the human parathyroid glands have been identified. Knowledge of different shapes of the parathyroid gland is essential for surgeon, sonologist, pathologist for better diagnosis and management of parathyroid diseases. Materials and Methods: A descriptive study was designed in the Department of Anatomy, Dhaka Medical College, Dhaka from January to December 2008 to see different shape of the parathyroid gland and was performed on post mortem parathyroid glands of 60 Bangladeshi people of different age, ranging from 15 to 75 years. A total of 207 parathyroid glands were taken from the cadavers. The samples were collected from the unclaimed dead bodies within 24-36 hours after death which were under examination in the Department of Forensic Medicine of Dhaka Medical College, Dhaka. Different shapes were observed by using a hand lens. Results: Parathyroid glands were found to be oval (35.76%), leaf shaped (27.43%), spherical (24.76%), tear-drop shaped (2.41%), rod like (4.83%), sausage like (1.93%), pancake shaped (1.44%) and bean shaped (1.44%). Key words: Parathyroid gland; shape of parathyroid. DOI: 10.3329/jdmc.v18i1.6305 J Dhaka Med Coll. 2009; 18(1) : 44-46

scholarly journals The case of late diagnosis of giant parathyroid adenoma in combination with fibrocystic osteitis and brown tumor of the upper jaw: a case report

2021 ◽  
Vol 67 (2) ◽  
pp. 49-56
Author(s):  
G. A. Bersenev ◽  
E. A. Ilyicheva ◽  
E. G. Griroryev
Keyword(s):  
Case Report ◽  
Parathyroid Adenoma ◽  
Parathyroid Gland ◽  
Malignant Neoplasm ◽  
Late Diagnosis ◽  
Focal Lesion ◽  
Brown Tumor ◽  
Increased Risk ◽  
Upper Jaw ◽  
The Right

In this case report the authors inform about late diagnosis of giant adenoma of the parathyroid gland with primary hyperparathyroidism (PHPT) and the development of fibrocystic osteitis with a «brown» tumor of the upper jaw. The patient has been under the care endocrinologist with type 2 diabetes mellitus and multinodular goiter for 8 years.The last 5 years there was a clinical manifestation of PHPT, but the diagnosis was made by an oncologist after the detection of a «brown» tumor of the upper jaw. According to multispiral computed tomography and scintigraphy with 99mTc-MIBI, a focal lesion was found in the upper jaw on the right, lytic foci in the bones of the cranial vault, pelvis, lower extremities, ribs on the right, as well as a giant parathyroid adenoma on the right. According to the increased risk of the patient having a malignant neoplasm of the parathyroid gland, an extended surgical treatment of PHPT in the enblock volume was carried out with the achievement of remission of the PHPT. This clinical case illustrates a variant of the severe course of PHPT with the development of such a rare complication as fibrocystic osteitis and demonstrates the importance of timely diagnosis.

Nodular hyperplasia of parathyroid gland in chronic kidney disease – A case report

2021 ◽  
Vol 8 (4) ◽  
pp. 503-507
Author(s):  
Dipti S Jadhav ◽  
Sawant Smita A
Keyword(s):  
Chronic Kidney Disease ◽  
Case Report ◽  
Kidney Disease ◽  
Parathyroid Adenoma ◽  
Parathyroid Gland ◽  
Accurate Diagnosis ◽  
Diagnostic Dilemma ◽  
Tertiary Hyperparathyroidism ◽  
Nodular Hyperplasia ◽  
Radiological Studies

Nodular hyperplasia of parathyroid gland is an advanced state commonly seen in a secondary and tertiary hyperparathyroidism. It shares similarities on histology with parathyroid adenoma creating a diagnostic dilemma. Adequate history, biochemical investigations and radiological studies majorly supports the accurate diagnosis. Identifying correct state of hyperparathyroidism is essential in a view of therapeutic management and its outcome.

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