Chemodectoma of carotid glomus coexisting with severe hypercalcemia masking parathyroid gland adenoma - diagnostic difficulties

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.

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Cancer of an ectopic parathyroid gland: from diagnosis to treatment (clinical case)

Modern Oncology ◽

10.26442/18151434.2020.4.200293 ◽

2021 ◽

Vol 22 (4) ◽

pp. 115-119

Author(s):

Arif K. Allakhverdiev ◽

Nataliya A. Malkina ◽

Karina K. Noskova ◽

Vyacheslav N. Grinevich ◽

Ilia Yu. Feidorov ◽

...

Keyword(s):

Parathyroid Gland ◽

Clinical Case ◽

Posterior Mediastinum ◽

Subsequent Treatment ◽

Immunological Study ◽

Ulcer Disease ◽

Main Complaint ◽

Severe Hypercalcemia ◽

Serum Pth ◽

Upper Mediastinum

The article presents a clinical case of a prolonged course of gastrointestinal ulcer disease, followed by dysphagia. During the examination, severe hyperparathyroidism was revealed, which subsequently prompted a diagnostic search for a parathyroid adenoma, which is the cause of hyperathyroidism in 8085% of cases. With instrumental methods of research, the cause of the main complaint is dysphagia, a formation in the posterior upper mediastinum up to 5 cm, compressing the esophagus. With transoesophageal aspiration biopsy (EUS-TYPE). The cytological picture is similar to the thyroid epithelium with part of the oncocytic differentiation. In an immunological study, lavage for parathyroid hormone showed high expression. Scintigraphy with Tc-99m pertechnetate revealed the exact topic of the formation of the parathyroid gland in the posterior mediastinum an atypical location. Surgical treatment was performed in the amount of thoracoscopic removal of the mediastinal tumor. The radical nature of the surgical intervention was confirmed by laboratory. Serum PTH levels decreased significantly. Upon receipt of the morphological conclusion, reliable data on malignant damage to the parathyroid gland were obtained. Subsequent treatment of the patient consisted in the correction of severe hypercalcemia in the postoperative period by prescribing denosumab, which led to the stabilization of the patients condition.

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Parathyroid gland before and after cisplatin treatment

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100128584 ◽

1987 ◽

Vol 45 ◽

pp. 860-861

Author(s):

S.K. Aggarwal ◽

J.M. Fadool

Keyword(s):

Parathyroid Gland ◽

Wistar Rats ◽

Antitumor Agent ◽

The Body ◽

Cross Linking ◽

Limiting Factor ◽

Hormonal Changes ◽

Primary Mechanism ◽

Before And After ◽

Dna Strands

Cisplatin (CDDP) a potent antitumor agent suffers from severe toxic side effects with nephrotoxicity being the major dose-limiting factor, The primary mechanism of its action has been proposed to be through its cross-linking DNA strands. It has also been shown to inactivate various transport enzymes and induce hypocalcemia and hypomagnesemia that may be the underlying cause for some of its toxicities. The present is an effort to study its influence on the parathyroid gland for any hormonal changes that control calcium levels in the body.Male Swiss Wistar rats (Crl: (WI) BR) weighing 200-300 g and of 60 days in age were injected (ip) with cisplatin (7mg/kg in normal saline). The controls received saline injections only. The animals were injected (iv) with calcium (0.5 ml of 10% calcium gluconate/day) and were killed by decapitation on day 1 through 5. Trunk blood was collected in heparinized tubes.

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Ultrastructural Studies of Bovine Respiratory Disease Complex

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100115766 ◽

1975 ◽

Vol 33 ◽

pp. 428-429

Author(s):

James C.S. Kim

Keyword(s):

Michigan State University ◽

State University ◽

Diagnostic Laboratory ◽

Ultrastructural Studies ◽

Bovine Respiratory Diseases ◽

Etiologic Agents ◽

Diagnostic Difficulties ◽

The Subject ◽

Capillary Walls ◽

Alveolar Capillary

Bovine respiratory diseases cause serious economic loses and present diagnostic difficulties due to the variety of etiologic agents, predisposing conditions, parasites, viruses, bacteria and mycoplasma, and may be multiple or complicated. Several agents which have been isolated from the abnormal lungs are still the subject of controversy and uncertainty. These include adenoviruses, rhinoviruses, syncytial viruses, herpesviruses, picornaviruses, mycoplasma, chlamydiae and Haemophilus somnus.Previously, we have studied four typical cases of bovine pneumonia obtained from the Michigan State University Veterinary Diagnostic Laboratory to elucidate this complex syndrome by electron microscopy. More recently, additional cases examined reveal electron opaque immune deposits which were demonstrable on the alveolar capillary walls, laminae of alveolar capillaries, subenthothelium and interstitium in four out of 10 cases. In other tissue collected, unlike other previous studies, bacterial organisms have been found in association with acute suppurative bronchopneumonia.

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