Albavera GLR, Pérez ÁCI, Jurado RJG, Santiago SC, Valdéz MHY

Language: Spanish
References: 11
Page: 226-234
PDF size: 332.24 Kb.

ABSTRACT

Background: Primary hyperparathyroidism is rarely caused by cystic degeneration of a parathyroid adenoma (1-2%), the clinical presentation may be asymptomatic, cause compression of cervical structures or severe hypercalcemia. We present the cases of two patients with a pre-surgical diagnosis of primary hyperparathyroidism and post-surgical histopathological report of parathyroid adenoma, with an atypical presentation due to the large size and cystic nature of the lesions.
Clinical cases: Case 1: A 56-year-old female patient with dysphagia and a retroesophageal cystic mass by tomography, in whom laboratory studies showed a classic biochemical pattern of primary hyperparathyroidism and a parathyroid scintigram with low uptake. Case 2: A 45-year-old female patient with episodes of renal lithiasis and primary hyperparathyroidism, localization studies revealed a cystic lesion adjacent to the right thyroid lobe, with a parathyroid scintigram with no uptake. Both patients underwent surgical resection with intraoperative histopathologic examination.
Conclusions: In patients with hypercalcemia, elevated parathyroid hormone levels, and a giant cystic mass in the neck, resection of the mass is necessary even if the diagnosis of parathyroid adenoma cannot be determined preoperatively. Intraoperative histopathologic examination is a useful resource.

REFERENCES

1. Weng J, Zhou W, Feng Y. Giant cystic parathyroidadenoma: two case reports and a literature review.J Int Med Res 2022; 50 (6): 3000605221106419. doi:10.1177/03000605221106419.

2. Rivers NJ, Linn DR, Buczek EP. Cystic parathyroid adenoma:Two cases of a rare phenomenon. Otolaryngology CaseReports 2020; 17: 100223.

3. El-Housseini Y, Hübner M, Boubaker A, Bruegger J, Matter M,Bonny O. Unusual presentations of functional parathyroidcysts: a case series and review of the literature. J Med CaseRep 2017; 11 (1): 333. doi: 10.1186/s13256-017-1502-1.

4. Khang AR, Kim EK, Nam EY, Byeon SJ, Kim JH, Ohn JH, etal. Primary hyperparathyroidism due to cystic parathyroidadenoma not detected on99mTc-sestamibi scan. EndocrinolMetab 2012; 27 (1): 83-88. DOI: https://doi.org/10.3803/EnM.2012.27.1.83.

5. Mahmodlou R, Sedokani A, Pezeshk A, Najafinejad B. Giantparathyroid adenoma: a case report. J Med Case Rep 2022;16 (1): 150. doi: 10.1186/s13256-022-03401-y.

6. Spanheimer PM, Stoltze AJ, Howe JR, Sugg SL, Lal G, WeigelRJ. Do giant parathyroid adenomas represent a distinct clinicalentity? Surgery 2013; 154 (4): 714-719. doi:10.1016/j.surg.2013.05.013.

7. Papavramidis TS, Chorti A, Pliakos I, Panidis S, MichalopoulosA. Parathyroid cysts: A review of 359 patients reportedin the international literature. Medicine (Baltimore) 2018;97 (28): e11399. doi:10.1097/MD.0000000000011399.

8. Asghar A, Ikram M, Islam N. A case report: Giant cysticparathyroid adenoma presenting with parathyroid crisisafter vitamin D replacement. BMC Endocr Disord 2012;12: 14. doi: 10.1186/1472-6823-12-14.

9. Davoli F, Rena O, Pirondini E, Casadio C. Quiste paratiroideofuncionante gigante de localización mediastínica: una causainsólita de disnea de esfuerzo y disfagia de carácter leve.Arch Bronconeumol 2013; 49 (9): 408-9. http://dx.doi.org/10.1016/j.arbres.2013.01.007.

10. Silva R, Cavadas D, Vicente C, Coutinho J. Parathyroid cyst:differential diagnosis. BMJ Case Reports 2020; 13 (10):e232017. doi: 10.1136/bcr-2019-232017.

11. Al-Hassan MS, Mekhaimar M, El Ansari W, Darweesh A,Abdelaal A. Giant parathyroid adenoma: a case report andreview of the literature. J Med Case Rep. 2019; 13 (1): 332.doi:10.1186/s13256-019-2257-7.