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Spillane C, Calpin G, Singh S, O’Reilly K, Hehir C, Hill A, Magee C, Barrett H. A case of mediastinal hyperparathyromatosis. J Surg Case Rep 2024; 2024:rjad735. [PMID: 38250132 PMCID: PMC10799250 DOI: 10.1093/jscr/rjad735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
Recurrent hyperparathyroidism (HPT) after initial parathyroid surgery occurs rarely in an ectopic location. The rare phenomenon of parathyromatosis may be the cause of this. We present the case of a 59-year-old woman with recurrent HPT, which presented as a new ectopic mediastinal parathyroid gland 13 years after initial 3.5 gland parathyroidectomy. A 1.5 × 1.3 cm lesion was discovered as an incidental finding in the pretracheal region, closely abutting the aortic arch. An aspirate revealed oncocytic cells, which were positive for parathyroid hormone, confirming a mediastinal parathyroid nodule. Sestamibi scan confirmed an avid nodule in the mediastinum. This patient had multiple co-morbidities but was asymptomatic of HPT. It was therefore decided at multi-disciplinary team discussion that she should undergo surveillance. To our knowledge, no such presentations have been reported in the literature. Thus, our case report is a unique addition of an atypical presentation of HPT.
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Affiliation(s)
- Chloe Spillane
- Department of Surgery, Beaumont Hospital, Beaumont Road, Beaumont, Dublin 9, D09V2N0, Ireland
| | - Gavin Calpin
- Department of Surgery, Beaumont Hospital, Beaumont Road, Beaumont, Dublin 9, D09V2N0, Ireland
| | - Sneha Singh
- Department of Surgery, Beaumont Hospital, Beaumont Road, Beaumont, Dublin 9, D09V2N0, Ireland
| | - Kasie O’Reilly
- Department of Surgery, Beaumont Hospital, Beaumont Road, Beaumont, Dublin 9, D09V2N0, Ireland
| | - Cian Hehir
- Department of Surgery, Beaumont Hospital, Beaumont Road, Beaumont, Dublin 9, D09V2N0, Ireland
| | - Arnold Hill
- Department of Surgery, Beaumont Hospital, Beaumont Road, Beaumont, Dublin 9, D09V2N0, Ireland
| | - Colm Magee
- Department of Medicine, Beaumont Hospital, Beaumont Road, Beaumont, Dublin 9, D09V2N0, Ireland
| | - Helen Barrett
- Department of Pathology, Beaumont Hospital, Beaumont Road, Beaumont, Dublin 9, D09V2N0, Ireland
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2
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Jha S, Simonds WF. Molecular and Clinical Spectrum of Primary Hyperparathyroidism. Endocr Rev 2023; 44:779-818. [PMID: 36961765 PMCID: PMC10502601 DOI: 10.1210/endrev/bnad009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/09/2023] [Accepted: 03/17/2023] [Indexed: 03/25/2023]
Abstract
Recent data suggest an increase in the overall incidence of parathyroid disorders, with primary hyperparathyroidism (PHPT) being the most prevalent parathyroid disorder. PHPT is associated with morbidities (fractures, kidney stones, chronic kidney disease) and increased risk of death. The symptoms of PHPT can be nonspecific, potentially delaying the diagnosis. Approximately 15% of patients with PHPT have an underlying heritable form of PHPT that may be associated with extraparathyroidal manifestations, requiring active surveillance for these manifestations as seen in multiple endocrine neoplasia type 1 and 2A. Genetic testing for heritable forms should be offered to patients with multiglandular disease, recurrent PHPT, young onset PHPT (age ≤40 years), and those with a family history of parathyroid tumors. However, the underlying genetic cause for the majority of patients with heritable forms of PHPT remains unknown. Distinction between sporadic and heritable forms of PHPT is useful in surgical planning for parathyroidectomy and has implications for the family. The genes currently known to be associated with heritable forms of PHPT account for approximately half of sporadic parathyroid tumors. But the genetic cause in approximately half of the sporadic parathyroid tumors remains unknown. Furthermore, there is no systemic therapy for parathyroid carcinoma, a rare but potentially fatal cause of PHPT. Improved understanding of the molecular characteristics of parathyroid tumors will allow us to identify biomarkers for diagnosis and novel targets for therapy.
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Affiliation(s)
- Smita Jha
- Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892-1752, USA
| | - William F Simonds
- Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892-1752, USA
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3
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Sapuppo G, Giusti MA, Aricò D, Masucci R, Tavarelli M, Russo M, Pellegriti G. Recurrent parathyromatosis in a patient with concomitant MEN1 and CASR gene alterations: Clinical management of a case report and literature review. Front Endocrinol (Lausanne) 2023; 14:1108278. [PMID: 36998475 PMCID: PMC10044612 DOI: 10.3389/fendo.2023.1108278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 03/02/2023] [Indexed: 03/17/2023] Open
Abstract
Introduction Parathyromatosis is a rare cause of primitive hyperparathyroidism characterized by the presence of numerous parathyroid tissue foci in the neck/mediastinum, due to hyperplasia of parathyroid embryologic residues (primary-form) or to local parathyroid tissue implantation (secondary-form). 63 cases have been described in the literature. In our patient parathyromatosis was due to a combination of two mutations. Case report A 36-years-old woman was diagnosed with osteoporosis secondary to primary hyperparathyroidism. Subsequent right parathyroidectomy showed a parathyroid adenoma. The follow-up was negative but after 10 years she had a relapse. The genetic screening showed a rare intronic mutation of the MEN1 gene and a heterozygous mutation never described in exon 8 of the CASR gene, coding for the calcium receptor. Calcemia and PTH increased over the years with the onset of nephrocalcinosis and the worsening of osteoporosis despite the therapy with Cinacalcet, bisphosphonates and Vitamin D. She had therefore two additional surgical procedures (parathyroid tissue without malignancy). At follow-up she showed elevated levels of PTH (>1000 pg/ml) and calcium (11.2 mg/dl) and CT scans multiple subcentimetric nodules in the neck/upper mediastinum. Since the 68Ga-DOTATATE showed an increased uptake in the neck/mediastinum, lanreotide was added. After two months there was a significant biochemical response but, unfortunately, after six months, the patient showed a new worsening. Conclusions a rare case of parathyromatosis due to a combination of two genetic alterations never described. The main issues concern the diagnosis and the radical treatment. Somatostatin analogues may have a useful role in both diagnosis and therapy.
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Affiliation(s)
- Giulia Sapuppo
- Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Medical Center, Catania, Italy
| | - Maria Ausilia Giusti
- Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Medical Center, Catania, Italy
| | - Demetrio Aricò
- Department of Nuclear Medicine, Humanitas Oncological Centre of Catania, Catania, Italy
| | - Romilda Masucci
- Clinical and Diagnostic Center, Giovan Battista (G.B.) Morgagni, Catania, Italy
| | - Martina Tavarelli
- Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Medical Center, Catania, Italy
| | - Marco Russo
- Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Medical Center, Catania, Italy
| | - Gabriella Pellegriti
- Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Medical Center, Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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Li L, He C, Cheng G, Cao J, Wang C, Tang Y, Zhang W. Recurrent renal secondary hyperparathyroidism caused by supernumerary mediastinal parathyroid gland and parathyromatosis: A case report. Front Surg 2023; 10:1135596. [PMID: 37021088 PMCID: PMC10067725 DOI: 10.3389/fsurg.2023.1135596] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 02/27/2023] [Indexed: 04/07/2023] Open
Abstract
Background Surgical parathyroidectomy (PTX) is necessary for patients with severe and progressive secondary hyperparathyroidism (SHPT) refractory to medical treatment. Recurrence of SHPT after PTX is a serious clinical problem. Both supernumerary mediastinal parathyroid gland and parathyromatosis are the rare causes of recurrent renal SHPT. We report a rare case of recurrent renal SHPT due to supernumerary mediastinal parathyroid gland and parathyromatosis. Case presentation A 53-year-old man underwent total parathyroidectomy with autotransplantation due to the drug-refractory SHPT 17 years ago. In the last 11 months, the patient experienced symptoms including bone pain and skin itch, and the serum intact parathyroid hormone (iPTH) level elevated to 1,587 pg/ml. Ultrasound detected two hypoechoic lesions located at the dorsal area of right lobe of the thyroid gland, and both lesions presented as characteristics of hyperparathyroidism in contrast-enhanced ultrasound. 99mTc-MIBI/SPECT detected a nodule in the mediastinum. A reoperation involved a cervicotomy for excising parathyromatosis lesions and the surrounding tissue and a thoracoscopic surgery for resecting a mediastinal parathyroid gland. According to a histological examination, two lesions behind the right thyroid lobe and one lesion in the central region had been defined as parathyromatosis. A nodule in the mediastinum was consistent with hyperplastic parathyroid. The patient remained well for 10 months with alleviated symptoms and stabilized iPTH levels in the range of 123-201 pg/ml. Conclusion Although rare, recurrent SHPT may be caused by a coexistence of both supernumerary parathyroid glands and parathyromatosis, which should receive more attention. The combination of imaging modalities is important for reoperative locations of parathyroid lesions. To successfully treat parathyromatosis, all the lesions and the surrounding tissue must be excised. Thoracoscopic surgery is a reliable and safe approach for the resection of ectopic mediastinal parathyroid glands.
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Affiliation(s)
- Longfei Li
- Department of Hepatobiliary and Thyroid Surgery, General Hospital of Northern Theater Command, Shenyang, China
| | - Chenchen He
- Department of Hepatobiliary and Thyroid Surgery, General Hospital of Northern Theater Command, Shenyang, China
- Department of Clinical Medicine and Surgery, China Medical University, Shenyang, China
| | - Guangming Cheng
- Department of Hepatobiliary and Thyroid Surgery, General Hospital of Northern Theater Command, Shenyang, China
| | - Junying Cao
- Department of Hepatobiliary and Thyroid Surgery, General Hospital of Northern Theater Command, Shenyang, China
| | - Chunhui Wang
- Department of Hepatobiliary and Thyroid Surgery, General Hospital of Northern Theater Command, Shenyang, China
| | - Yufu Tang
- Department of Hepatobiliary and Thyroid Surgery, General Hospital of Northern Theater Command, Shenyang, China
- Correspondence: Yufu Tang Wei Zhang
| | - Wei Zhang
- Department of Hepatobiliary and Thyroid Surgery, General Hospital of Northern Theater Command, Shenyang, China
- Correspondence: Yufu Tang Wei Zhang
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Perrier N, Lang BH, Farias LCB, Poch LL, Sywak M, Almquist M, Vriens MR, Yeh MW, Shariq O, Duh QY, Yeh R, Vu T, LiVolsi V, Sitges-Serra A. Surgical Aspects of Primary Hyperparathyroidism. J Bone Miner Res 2022; 37:2373-2390. [PMID: 36054175 DOI: 10.1002/jbmr.4689] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 08/18/2022] [Accepted: 08/24/2022] [Indexed: 11/12/2022]
Abstract
Parathyroidectomy (PTX) is the treatment of choice for symptomatic primary hyperparathyroidism (PHPT). It is also the treatment of choice in asymptomatic PHPT with evidence for target organ involvement. This review updates surgical aspects of PHPT and proposes the following definitions based on international expert consensus: selective PTX (and reasons for conversion to an extended procedure), bilateral neck exploration for non-localized or multigland disease, subtotal PTX, total PTX with immediate or delayed autotransplantation, and transcervical thymectomy and extended en bloc PTX for parathyroid carcinoma. The systematic literature reviews discussed covered (i) the use of intraoperative PTH (ioPTH) for localized single-gland disease and (ii) the management of low BMD after PTX. Updates based on prospective observational studies are presented concerning PTX for multigland disease and hereditary PHPT syndromes, histopathology, intraoperative adjuncts, localization techniques, perioperative management, "reoperative" surgery and volume/outcome data. Postoperative complications are few and uncommon (<3%) in centers performing over 40 PTXs per year. This review is the first global consensus about surgery in PHPT and reflects the current practice in leading endocrine surgery units worldwide. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Nancy Perrier
- Department of Surgical Oncology, Section of Surgical Endocrinology, University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Brian H Lang
- Department of Surgery, Queen Mary Hospital, Pokfulam, Hong Kong
| | | | - Leyre Lorente Poch
- Endocrine Surgery Unit, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mark Sywak
- Endocrine Surgery Unit, University of Sydney, Sydney, Australia
| | - Martin Almquist
- Department of Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Menno R Vriens
- Department of Surgical Oncology and Endocrine Surgery, University Medical Center, Utrecht, The Netherlands
| | - Michael W Yeh
- Department of Surgery, Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Omair Shariq
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, University of Oxford, Headington, UK
| | - Quan-Yang Duh
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Randy Yeh
- Memorial Sloan Kettering Cancer Center, Molecular Imaging and Therapy Service, New York, NY, USA
| | - Thinh Vu
- Neuroradiology Department, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Virginia LiVolsi
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Latgé A, Averous G, Helali M, Bachellier P, Imperiale A. Parathyromatosis: a challenging cause of recurrent primary hyperparathyroidism. QJM 2022; 115:235-236. [PMID: 35166836 DOI: 10.1093/qjmed/hcac042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Latgé
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe (ICANS), Université de Strasbourg, 17, rue Albert Calmette, 67093 Strasbourg, France
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe (ICANS), Université de Strasbourg, 17, rue Albert Calmette, 67093 Strasbourg, France
| | - G Averous
- Pathology, University Hospitals of Strasbourg, University of Strasbourg, 1, Avenue Molière, 67200 Strasbourg, France
- Pathology, University Hospitals of Strasbourg, University of Strasbourg, 1, Avenue Molière, 67200 Strasbourg, France
| | - M Helali
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe (ICANS), Université de Strasbourg, 17, rue Albert Calmette, 67093 Strasbourg, France
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe (ICANS), Université de Strasbourg, 17, rue Albert Calmette, 67093 Strasbourg, France
| | - P Bachellier
- Hepato-Pancreato-Biliary Surgery and Liver transplantation, University Hospitals of Strasbourg, University of Strasbourg, 1, Avenue Molière, 67200 Strasbourg, France
- Hepato-Pancreato-Biliary Surgery and Liver transplantation, University Hospitals of Strasbourg, University of Strasbourg, 1, Avenue Molière, 67200 Strasbourg, France
| | - A Imperiale
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe (ICANS), Université de Strasbourg, 17, rue Albert Calmette, 67093 Strasbourg, France and Molecular Imaging-DRHIM, IPHC, UMR 7178, CNRS/Unistra, Strasbourg, France
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe (ICANS), Université de Strasbourg, 17, rue Albert Calmette, 67093 Strasbourg, France and Molecular Imaging-DRHIM, IPHC, UMR 7178, CNRS/Unistra, Strasbourg, France
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Tzotzas T, Goropoulos A, Karras S, Terzaki A, Siolos A, Doumas A, Zaramboukas T, Tigas S. Effective long-term management of parathyromatosis-related refractory hypercalcemia with a combination of denosumab and cinacalcet treatment. Hormones (Athens) 2022; 21:171-176. [PMID: 34993886 DOI: 10.1007/s42000-021-00343-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 12/07/2021] [Indexed: 11/24/2022]
Abstract
Parathyromatosis is a rare cause of persistent or recurrent primary hyperparathyroidism and hypercalcemia due to the presence of hyperfunctioning foci of parathyroid tissue in the neck and/or mediastinum. We describe the case of a male patient who presented with severe hypercalcemia and a left-sided palpable parathyroid mass. Over the course of the next 18 years, the patient underwent neck exploration surgery on multiple occasions due to recurrent primary hyperparathyroidism and refractory hypercalcemia, complicated by nephrolithiasis and impairment of renal function, while bone mineral density was preserved. Histological findings and the natural course of the disease were consistent with parathyromatosis. Medical interventions with oral bisphosphonates or high-dose cinacalcet failed to control the patient's hypercalcemia. The combination of monthly denosumab and cinacalcet was, however, successful in maintaining the patient's serum calcium in the normal/upper-normal range over a 36-month period with no significant side effects. This is the first report of off-label denosumab use in combination with cinacalcet in the long-term management of parathyromatosis-related refractory hypercalcemia.
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Affiliation(s)
| | | | - Spyridon Karras
- Postdoctoral Researcher-National Scholarship Foundation, Thessaloniki, Greece
| | - Alexandra Terzaki
- Department of Endocrinology, University of Ioannina, Ioannina, Greece
| | - Athanasios Siolos
- Department of Endocrinology, University of Ioannina, Ioannina, Greece
| | - Argyrios Doumas
- Nuclear Medicine Department, AHEPA University Hospital, Thessaloniki, Greece
| | | | - Stelios Tigas
- Department of Endocrinology, University of Ioannina, Ioannina, Greece
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Valizadeh M, Ebadinejad A, Amouzegar A, Zakeri A. Persistent hyperparathyroidism secondary to ectopic parathyroid adenoma in lung: Case report. Front Endocrinol (Lausanne) 2022; 13:988035. [PMID: 36583007 PMCID: PMC9792501 DOI: 10.3389/fendo.2022.988035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 11/23/2022] [Indexed: 12/15/2022] Open
Abstract
Primary hyperparathyroidism (PHPT) is the most prevalent cause of hypercalcemia, affecting 0.3% of the population. The only curative procedure is parathyroidectomy. Persistent PHPT occurs in 4.7 percent of patients, even in the most skilled hands. Ectopic adenomas are challenging to localize before and during surgery and frequently result in persistent PHPT. We presented a case with persistent PHPT due to lung parathyroid adenoma that was successfully resected with video-assisted thoracoscopic surgery. A 55-year-old female patient was admitted to our endocrinology clinic with persistent PHPT after four neck explorations over 16 years. The last 99m Tc-MIBI scintigraphy with SPECT showed nothing suggestive of parathyroid adenoma, neither in the neck nor the mediastinum, but a solitary nodule as an incidental finding was reported in the lower lobe of the right lung, which was highly probable for a parathyroid adenoma in a fluorodeoxyglucose PET scan. Pathological examination ruled out parathyromatosis and lung malignancy; despite its location outside the anticipated embryonic pathway, pathology revealed the presence of an ectopic parathyroid adenoma. After the surgery, serum parathyroid hormone and calcium levels decreased, and hypoparathyroidism was corrected with calcium carbonate and calcitriol.
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Affiliation(s)
- Majid Valizadeh
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Ebadinejad
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atieh Amouzegar
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Anahita Zakeri
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Internal Medicine, Emam Khomeini Hospital, Ardabil University of Medical Science, Ardabil, Iran
- *Correspondence: Anahita Zakeri, ;
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Carral F, Jiménez AI, Tomé M, Alvarez J, Díez A, García C, Vega V, Ayala C. Seguridad y rendimiento diagnóstico de la medición de PTH en el lavado del aspirado de lesiones sospechosas de adenomas de paratiroides. ENDOCRINOL DIAB NUTR 2021. [DOI: 10.1016/j.endinu.2020.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Carral F, Jiménez AI, Tomé M, Alvarez J, Díez A, García C, Vega V, Ayala C. Safety and diagnostic performance of parathyroid hormone assay in fine-needle aspirate in suspicious parathyroid adenomas. ENDOCRINOL DIAB NUTR 2021; 68:481-488. [PMID: 34863413 DOI: 10.1016/j.endien.2020.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/22/2020] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To evaluate the safety and diagnostic performance of parathyroid hormone assay in fine-needle aspirate (PTH-FNA) in patients with primary hyperparathyroidism and suspicious parathyroid adenomas. METHODOLOGY A retrospective observational study was performed in 47 patients (57.7 ± 11.2 years of average age, 74% women) attending an endocrinology clinic for primary hyperparathyroidism (average calcemia: 11.6 ± 1.6 mg/dl and PTH: 276 ± 477 pg/mL) in which PTH-FNA was made. Sensibility, specificity, positive predictive value and negative predictive value were calculated in all surgical patients. RESULTS Forty-seven lesions were punctured (mean adenoma maximum diameter: 1.8 ± 2.6 cm): negative image in the sestamibi scan (26 patients); the discordance between ultrasonography and the sestamibi scan (6 patients); possible intrathyroidal adenomas (4 patients); a positive sestamibi scan in 2 or more localizations (4 patients); ectopic adenoma (3 patients); persistent primary hyperparathyroidism (2 patients) and atypical adenomas (2 patients). Mean PTH-FNA was 2853 ± 3957 pg/mL and 68% were considered positive (PTH-FNA ≥ 100 pg/mL). No complications were detected during or after the puncture. Thirty-seven patients were operated on, 95% were cured and no parathyromatosis cases were detected. PTH-FNA ≥ 100 pg/mL as a diagnostic test had a sensitivity of 93.7%, a specificity of 100%, a positive predictive value of 100% and an negative predictive value of 71.4%. CONCLUSION PTH-FNA is an easy and safe diagnostic test and has a high sensitivity and specificity for differentiating between parathyroid adenomas and other cervical masses in patients with primary hyperparathyroidism.
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Affiliation(s)
- Florentino Carral
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Puerto Real, Puerto Real, Cádiz, Spain.
| | - Ana Isabel Jiménez
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Puerto Real, Puerto Real, Cádiz, Spain
| | - Mariana Tomé
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Puerto Real, Puerto Real, Cádiz, Spain
| | - Javier Alvarez
- Unidad de Gestión Clínica de Cirugía General y Digestiva, Hospital Universitario Puerto Real, Puerto Real, Cádiz, Spain
| | - Ana Díez
- Unidad de Gestión Clínica de Cirugía General y Digestiva, Hospital Universitario Puerto Real, Puerto Real, Cádiz, Spain
| | - Concepción García
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Puerto Real, Puerto Real, Cádiz, Spain
| | - Vicente Vega
- Unidad de Gestión Clínica de Cirugía General y Digestiva, Hospital Universitario Puerto Real, Puerto Real, Cádiz, Spain
| | - Carmen Ayala
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Puerto Real, Puerto Real, Cádiz, Spain
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11
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Appelman-Dijkstra NM, Ertl DA, Zillikens MC, Rjenmark L, Winter EM. Hypercalcemia during pregnancy: management and outcomes for mother and child. Endocrine 2021; 71:604-610. [PMID: 33544354 PMCID: PMC8016748 DOI: 10.1007/s12020-021-02615-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/08/2021] [Indexed: 11/28/2022]
Abstract
Diagnosing and treating hypercalcemia during pregnancy can be challenging due to both the physiological changes in calcium homeostasis and the underlying cause for the hypercalcemia. During pregnancy and lactation there is increased mobilization of calcium in the mother to meet the fetus' calcium requirements. Here we discuss the diagnostic challenges, management, and patient perspective of hypercalcemia during pregnancy in two particular cases and in other rare conditions causing hypercalcemia.
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Affiliation(s)
- Natasha M Appelman-Dijkstra
- Department of Internal Medicine, Division of Endocrinology, Center for Bone Quality, Leiden University Medical Center, Leiden, the Netherlands.
| | - Diana- Alexandra Ertl
- Department for Pediatric Pulmonology, Allergology and Endocrinology, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
- Center of Expertise for Rare Disorders of Bone, Growth and Mineralization, Vienna Bone and Growth Center, Vienna, Austria
| | - M C Zillikens
- Department of Internal Medicine, Erasmus MC Bone Center, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Lars Rjenmark
- Department of Clinical Medicine; Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Elizabeth M Winter
- Department of Internal Medicine, Division of Endocrinology, Center for Bone Quality, Leiden University Medical Center, Leiden, the Netherlands
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12
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Yang J, Zhang J, Liu NH, Liu H, Dong MJ. Persistent secondary hyperparathyroidism caused by parathyromatosis and supernumerary parathyroid glands in a patient on haemodialysis. BMC Nephrol 2020; 21:257. [PMID: 32631272 PMCID: PMC7339528 DOI: 10.1186/s12882-020-01917-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/29/2020] [Indexed: 11/21/2022] Open
Abstract
Background Secondary hyperparathyroidism (SHPT) is a common high-risk factor for mortality in end-stage renal disease, and parathyromatosis and supernumerary parathyroid glands are very rare causes of persistent SHPT. Preoperative diagnosis and removal of all hyperplastic parathyroid glands are challenging. We report a rare case of persistent SHPT due to parathyromatosis and supernumerary parathyroid glands and successful management by multiple imaging modalities. Case presentation A 53-year-old Chinese woman on haemodialysis experienced discomfort due to itching and bone pain due to persistent SHPT after parathyroidectomy. The supernumerary parathyroid glands and parathyromatosis were detected by multiple imaging modalities, including 99mTc-sestamibi (99mTc-MIBI) scans, ultrasonography and four-dimensional computed tomography (4D-CT) and then excised; pathological confirmation was performed. During follow-up, her serum calcium and parathyroid hormone levels were stable in the appropriate ranges, and no complications arose. Conclusions Because of persistent SHPH after parathyroidectomy in patients with haemodialysis, multiple imaging modalities, including 99mTc-MIBI scans, 4D-CT and ultrasonography, are helpful for detecting supernumerary parathyroid glands and parathyromatoses. Accurate preoperative localization of this rare lesion is important for management, enabling the removal of all affected parathyroid tissues.
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Affiliation(s)
- Jun Yang
- The Department of Nuclear Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, 310003, Hangzhou, People's Republic of China
| | - Jun Zhang
- The Department of Nuclear Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, 310003, Hangzhou, People's Republic of China
| | - Ning-Hu Liu
- The Department of Nuclear Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, 310003, Hangzhou, People's Republic of China
| | - Hao Liu
- The Department of Nuclear Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, 310003, Hangzhou, People's Republic of China
| | - Meng-Jie Dong
- The Department of Nuclear Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, 310003, Hangzhou, People's Republic of China.
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13
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Cao H, Zeng M, Fang H, Tang L, Liu W. Parathyromatosis type 2 detected by 99mTc-MIBI SPECT/CT. Gland Surg 2019; 8:806-809. [PMID: 32042690 DOI: 10.21037/gs.2019.11.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Parathyromatosis, which is defined as multiple foci of benign hyperfunctioning parathyroid tissue in neck or mediastinum, is a rare but severe cause of persistent/recurrent renal hyperparathyroidism (rHPT) after parathyroidectomy (PTX). It is hard to detect and remove all the foci. We present a case of parathyromatosis in a haemodialysed patient, who had three PTXs for persistent/recurrent rHPT and was free of recurrence during 31-month follow-up after the third PTX. 99mTc-MIBI SPECT/CT scan prior to the third PTX located all the lesions. The presented case suggests that preoperative 99mTc-MIBI SPECT/CT is useful for successful surgical removal of parathyromatosis.
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Affiliation(s)
- Huixiao Cao
- Department of Nuclear Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Ming Zeng
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Haisheng Fang
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Lijun Tang
- Department of Nuclear Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Wei Liu
- Department of Nuclear Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
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14
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Haciyanli M, Karaisli S, Gucek Haciyanli S, Atasever A, Arikan Etit D, Gur EO, Acar T. Parathyromatosis: a very rare cause of recurrent primary hyperparathyroidism - case report and review of the literature. Ann R Coll Surg Engl 2019; 101:e178-e183. [PMID: 31509000 DOI: 10.1308/rcsann.2019.0105] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Parathyromatosis is a rare entity and usually appears as a consequence of the seeding on previous parathyroid surgery which was applied for the secondary hyperparathyroidism. A 63-year-old woman presented with a history of subtotal thyroidectomy 20 years ago and parathyroidectomy due to primary hyperparathyroidism (PHPT) four years ago. Imaging methods revealed multiple parathyromatosis foci on subcutaneous tissue of the neck. En-bloc resection was performed and pathological examination confirmed the diagnosis of parathyromatosis. After an uneventful 10 months, biochemical and radiological tests revealed recurrence on bilateral thyroid lodges. En-bloc resection was performed. The patient has remained well for 24 months after the second operation and has been followed-up with normal parathormone and serum calcium values. To the best of our knowledge, this report describes the twenty-first case of parathyromatosis in PHPT setting in the literature. It should be kept in mind that parathyromatosis may recur at different sites in the neck even in patients with PHPT.
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Affiliation(s)
- M Haciyanli
- Department of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - S Karaisli
- Department of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - S Gucek Haciyanli
- Department of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - A Atasever
- Department of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - D Arikan Etit
- Department of Pathology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - E O Gur
- Department of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - T Acar
- Department of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
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15
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Wei AE, Garrett MR, Gupta A. PARATHYROMATOSIS: A RARE CASE OF RECURRENT HYPERPARATHYROIDISM LOCALIZED BY FOUR-DIMENSIONAL COMPUTED TOMOGRAPHY. AACE Clin Case Rep 2019; 5:e384-e387. [PMID: 31967077 DOI: 10.4158/accr-2019-0225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/08/2019] [Indexed: 11/15/2022] Open
Abstract
Objective To present a rare case of parathyromatosis. Methods We present the clinical, laboratory, and imaging findings, along with a review of the literature. Results A 33-year-old man with a history of right upper parathyroid adenoma removal 5 years prior due to hyperparathyroidism was admitted for severe hypercalcemia (15.6 mg/dL; normal, 8.5 to 10.5 mg/dL) with elevated plasma parathyroid hormone (PTH) (882 pg/mL; normal, 15 to 65 pg/mL). Ultrasound, computed tomography (CT), sestamibi, and positron emission tomography scans were unremarkable; however, a four-dimensional CT (4DCT) of the neck showed an area of increased signal enhancement and hypervascularity without discrete nodule in the posterior right thyroid region. The patient underwent parathyroid surgical exploration with right hemithyroidectomy and compartment neck dissection to remove the affected tissue. PTH levels dropped to 208 pg/mL postoperatively; calcium decreased but remained elevated at 12.7 mg/dL. Pathology revealed the presence of several small nodular foci of atypical hyperplastic parathyroid tissue in the right thyroid and soft tissue in the left central neck compartment consistent with parathyromatosis. Conclusion This case report represents the first-time use of 4DCT to localize parathyromatosis. Parathyromatosis is a rare but problematic cause of recurrent hyperparathyroidism. Ultrasound and 4DCT may represent the best imaging modalities for identification and perioperative management to remove all affected tissue without reseeding.
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16
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Pan B, Wang A, Pang J, Zhang Y, Cui M, Sun J, Liang Z. Programmed death ligand 1 (PD-L1) expression in parathyroid tumors. Endocr Connect 2019; 8:887-897. [PMID: 31252398 PMCID: PMC6599073 DOI: 10.1530/ec-19-0163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 06/06/2019] [Indexed: 11/08/2022]
Abstract
INTRODUCTION PD-L1 is associated with prognosis and immunotherapeutic response in patients with malignancies. In previous studies, PD-L1 expression was detected in many endocrine tumors. However, the PD-L1 expression status in parathyroid tumors is unknown. METHODS We included 26 parathyroid carcinoma and 37 adenoma samples, as well as the corresponding patient information. PD-L1 was stained using the FDA-approved PD-L1 IHC 22C3 pharmDx and Ventana PD-L1 (SP263) assays, and staining was assessed by the estimated percentages of positive tumor cells and immune cells, respectively. RESULTS We classified the PD-L1 expression in the parathyroid tumors into four groups: (0) <1%, (1) 1-4%, (2) 5-9% and (3) ≥10% positive. With the SP263 clone, 37 (carcinoma:adenoma = 18:19) samples scored 0, 13 (carcinoma:adenoma = 4:9) scored 1, 7 (carcinoma:adenoma = 1:6) scored 2 and 6 (carcinoma:adenoma = 3:3) scored 3. However, in the series of cases using the 22C3 clone, 45 (carcinoma:adenoma = 20:25) samples scored 0, 10 (carcinoma: adenoma = 3:7) scored 1, 5 (carcinoma:adenoma = 1:4) scored 2, and 3 (carcinoma:adenoma = 2:1) scored 3. Concerning tumor-infiltrating immune cells, 57 samples were negative and six were positive with SP263, and 59 were negative and four were positive with 22C3. Moreover, PD-L1 expression was negatively correlated with the Ki-67 index and mitotic rate in parathyroid tumors depending on the different clones. However, the results indicated only moderate consistency between the SP263 and 22C3 clones in parathyroid tumors. CONCLUSION We found deficient PD-L1 expression in the majority of parathyroid tumors. However, the PD-L1 expression score in parathyroid tumors depended greatly on the antibody clone used.
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Affiliation(s)
- Boju Pan
- Department of Pathology, Molecular Pathology Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Anqi Wang
- Clinical Biobank, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Junyi Pang
- Department of Pathology, Molecular Pathology Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuhan Zhang
- Department of Pathology, Molecular Pathology Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ming Cui
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jian Sun
- Department of Pathology, Molecular Pathology Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Correspondence should be addressed to J Sun or Z Liang: or
| | - Zhiyong Liang
- Department of Pathology, Molecular Pathology Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Correspondence should be addressed to J Sun or Z Liang: or
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17
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Miller MJ, Agrawal N, Katz G, Ogilvie J, Melamed J. Parathyromatosis with a papillary architecture. Histopathology 2019; 75:598-602. [PMID: 31152597 DOI: 10.1111/his.13928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
| | - Nidhi Agrawal
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, NYU Langone Health, New York, NY, USA
| | - Gillian Katz
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, NYU Langone Health, New York, NY, USA
| | - Jennifer Ogilvie
- Department of Surgery, Division of Endocrine Surgery, NYU Langone Health, New York, NY, USA
| | - Jonathan Melamed
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, NYU Langone Health, New York, NY, USA
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18
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Takada D, Tsukamoto T, Fuse M, Kada S, Yanagita M. The use of cinacalcet hinders the diagnosis of parathyroid carcinoma in a chronic dialysis patient: a case report. BMC Nephrol 2017; 18:315. [PMID: 29047366 PMCID: PMC5648519 DOI: 10.1186/s12882-017-0733-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 09/28/2017] [Indexed: 12/15/2022] Open
Abstract
Background Secondary hyperparathyroidism (SHPT) is a common complication in patients receiving chronic dialysis therapy. Although cinacalcet can control parathyroid function and bone turnover, preventing ectopic calcification remains challenging. Cinacalcet can also suppress PTH secretion due to parathyroid carcinoma in the same way as it does for parathyroid hyperplasia in the uremic condition. We present a case of parathyroid carcinoma partially controlled by cinacalcet, in which tumorous calcinosis was successfully resolved by total parathyroidectomy. Case presentation A female patient in her forties who had received dialysis for 12 years was referred to our hospital for painful ectopic calcifications on her right hip joint and both knees. Although she had been treated with alfacalcidol and cinacalcet for 2 years, this therapy had been discontinued 6 months earlier as a result of hypercalcemia. The patient exhibited normocalcemia (2.37 mmol/L) and hyperphosphatemia (2.42 mmol/L) with elevated intact parathyroid hormone (707,000 μg/L). Ultrasonography revealed an enlarged parathyroid gland on the left lower side of the thyroid gland. The otolaryngologist surgeons had to perform an en bloc excision to remove this parathyroid gland because of tight adhesions. Histological examination revealed that parathyroid cells had invaded the surrounding skeletal muscle through fibrous capsules, consistent with parathyroid carcinoma. Her joint pain disappeared 2 weeks after parathyroidectomy, and the tumorous calcinosis had largely resolved after 1 year. Conclusions Parathyroid carcinoma is a rare cause of hyperparathyroidism in end-stage kidney disease. Our case indicates that the use of cinacalcet hinders the diagnosis of parathyroid carcinoma in a chronic dialysis patient. When uncontrolled hypercalcemia and/or hyperphosphathemia develop during cinacalcet administration, parathyroidectomy should be considered to prevent a vicious exacerbation of ectopic calcification.
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Affiliation(s)
- Daisuke Takada
- Department of Nephrology, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo, Kyoto, Japan. .,Department of Nephrology & Dialysis, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, Osaka, Japan.
| | - Tatsuo Tsukamoto
- Department of Nephrology, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo, Kyoto, Japan.,Department of Nephrology & Dialysis, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Miho Fuse
- Department of Otorhinolaryngology, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shinpei Kada
- Department of Otorhinolaryngology, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Motoko Yanagita
- Department of Nephrology, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo, Kyoto, Japan
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19
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Aggarwal A, Wadhwa R, Aggarwal V. Parathyromatosis Following Endoscopic Parathyroid Surgery: A Rare Occurrence. Indian J Endocrinol Metab 2017; 21:641-642. [PMID: 28670557 PMCID: PMC5477461 DOI: 10.4103/ijem.ijem_61_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Ajay Aggarwal
- Department of Endocrinology, Fortis Hospital, Shalimar Bagh, New Delhi, India
| | - Roopak Wadhwa
- Department of Endocrinology, Fortis Hospital, Shalimar Bagh, New Delhi, India
| | - Vivek Aggarwal
- Department of Endocrine Surgery, Fortis Hospital, Shalimar Bagh, New Delhi, India
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20
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Guerin C, Paladino NC, Lowery A, Castinetti F, Taieb D, Sebag F. Persistent and recurrent hyperparathyroidism. Updates Surg 2017; 69:161-169. [PMID: 28434176 DOI: 10.1007/s13304-017-0447-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 04/08/2017] [Indexed: 12/26/2022]
Abstract
Despite remarkable progress in imaging modalities and surgical management, persistence or recurrence of primary hyperparathyroidism (PHPT) still occurs in 2.5-5% of cases of PHPT. The aim of this review is to expose the management of persistent and recurrent hyperparathyroidism. A literature search was performed on MEDLINE using the search terms "recurrent" or "persistent" and "hyperparathyroidism" within the past 10 years. We also searched the reference lists of articles identified by this search strategy and selected those we judged relevant. Before considering reoperation, the surgeon must confirm the diagnosis of PHPT. Then, the patient must be evaluated with new imaging modalities. A single adenoma is found in 68% of cases, multiglandular disease in 28%, and parathyroid carcinoma in 3%. Others causes (<1%) include parathyromatosis and graft recurrence. The surgeon must balance the benefits against the risks of a reoperation (permanent hypocalcemia and recurrent laryngeal nerve palsy). If surgery is necessary, a focused approach can be considered in cases of significant imaging foci, but in the case of multiglandular disease, a bilateral neck exploration could be necessary. Patients with multiple endocrine neoplasia syndromes are at high risk of recurrence and should be managed regarding their hereditary pathology. The cure rate of persistent-PHPT or recurrent-PHPT in expert centers is estimated from 93 to 97%. After confirming the diagnosis of PHPT, patients with persistent-PHPT and recurrent-PHPT should be managed in an expert center with all dedicated competencies.
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Affiliation(s)
- Carole Guerin
- Department of Endocrine Surgery, La Conception Hospital, Assistance Publique Hopitaux de Marseille, 147 BD Baille, 13005, Marseille, France. .,Aix-Marseille University, Medical School, 27, bd Jean Moulin, 13385, Marseille Cedex 05, France.
| | - Nunzia Cinzia Paladino
- Department of Endocrine Surgery, La Conception Hospital, Assistance Publique Hopitaux de Marseille, 147 BD Baille, 13005, Marseille, France
| | - Aoife Lowery
- Department of Surgery, University Hospital Limerick and Graduate Entry Medical School University of Limerick, Limerick, Ireland
| | - Fréderic Castinetti
- Aix-Marseille University, Medical School, 27, bd Jean Moulin, 13385, Marseille Cedex 05, France.,Department of Endocrinology, La Conception Hospital, Assistance Publique Hopitaux de Marseille, 147 BD Baille, 13005, Marseille, France
| | - David Taieb
- Aix-Marseille University, Medical School, 27, bd Jean Moulin, 13385, Marseille Cedex 05, France.,Department of Nuclear Medicine, La Timone Hospital, Assistance Publique Hopitaux de Marseille, 264 Rue Saint-Pierre, 13385, Marseille, France
| | - Fréderic Sebag
- Department of Endocrine Surgery, La Conception Hospital, Assistance Publique Hopitaux de Marseille, 147 BD Baille, 13005, Marseille, France.,Aix-Marseille University, Medical School, 27, bd Jean Moulin, 13385, Marseille Cedex 05, France
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21
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Jain M, Krasne DL, Singer FR, Giuliano AE. Recurrent primary hyperparathyroidism due to Type 1 parathyromatosis. Endocrine 2017; 55:643-650. [PMID: 27743301 DOI: 10.1007/s12020-016-1139-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 09/24/2016] [Indexed: 10/20/2022]
Abstract
Parathyromatosis is a rare condition consisting of multiple nodules of benign hyperfunctioning parathyroid tissue scattered throughout the neck and superior mediastinum. As a potential cause of recurrent or persistent hyperparathyroidism, parathyromatosis is a challenging condition to diagnose and treat. The optimal evaluation and management of patients with parathyromatosis is not well established. The reported case involves a patient who was initially diagnosed with primary hyperparathyroidism. The diagnosis of Type 1 parathyromatosis was made after the patient developed recurrent hyperparathyroidism with hypercalcemia and osteoporosis 17 years after the initial operation and underwent two additional operations. The majority of parathyromatosis cases are diagnosed in the setting of secondary hyperparathyroidism. Consensus regarding the preoperative diagnosis and evaluation is lacking due to the paucity of cases of this rare clinical entity. Management involves complete surgical extirpation of all identifiable rests of parathyroid tissue. Intra-operative parathyroid hormone level monitoring and frozen section examination are excellent tools that could increase the rates of initial operative success. Despite this, long-term disease remission is rare, and medical therapy, including calcimimetics and bisphosphonates, may be required for postoperative or non-operative management.
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Affiliation(s)
- Monica Jain
- Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA.
| | - David L Krasne
- Department of Pathology, Providence Saint John's Health Center, 2121 Santa Monica Blvd, Santa Monica, CA, 90404, USA
| | - Frederick R Singer
- Endocrine/Bone Disease Program, John Wayne Cancer Institute at Providence Saint John's Health Center, 2121 Santa Monica Blvd, Santa Monica, CA, 90404, USA
| | - Armando E Giuliano
- Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
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22
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Nakamura M, Tanaka K, Fujii T. Hyperparathyroidism caused by distant pulmonary lesions and parathyromatosis after ethanol injection/parathyroidectomy for secondary hyperparathyroidism. Hemodial Int 2017; 21:E45-E49. [PMID: 28078796 DOI: 10.1111/hdi.12525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Secondary hyperparathyroidism (SHPT) treatment includes parathyroidectomy and percutaneous ethanol injection therapy (PEIT), which are invasive procedures. The condition in which benign hyperfunctioning parathyroid tissue is distributed throughout the neck and mediastinum is termed parathyromatosis. Here, we present the case of a 51-year-old woman who began hemodialysis in 1986 due to chronic kidney disease of unknown etiology and developed SHPT in 1999. She underwent 6 rounds of PEIT followed by total a parathyroidectomy with partial forearm autotransplantation. Between 2011 and 2013, surgeons removed several nodules from her pulmonary and cervical regions and the transplanted masses from her forearm; all showed hyperplasia but exhibited no histological evidence of malignancy. Damage to the parathyroid capsule after repeated PEITs may cause local cervical recurrence and pulmonary lesions, although distant lesions are extremely rare in SHPT. This case is of interest due to the possible association between PEIT and parathyromatosis and distal lesions.
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Affiliation(s)
- Michio Nakamura
- Department of Transplant Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | | | - Takeshi Fujii
- Department of Pathology, Toranomon Hospital, Minatoku, Tokyo, Japan
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23
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Edling KL, Korenman SG, Janzen C, Sohsman MY, Apple SK, Bhuta S, Yeh MW. A pregnant dilemma: primary hyperparathyroidism due to parathyromatosis in pregnancy. Endocr Pract 2016; 20:e14-7. [PMID: 24013984 DOI: 10.4158/ep13105.cr] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To describe an exceedingly rare case of parathyromatosis in pregnancy and the limited medical treatment options available for such cases that are refractory to surgery. METHODS Case presentation and description of clinical course with brief review of the literature. RESULTS A 21-year-old woman with a history of 3.5 gland parathyroidectomy presented with severe hyperemesis during her first trimester of pregnancy and was found to have primary hyperparathyroidism attributable to parathyromatosis. We describe the diagnostic and management dilemmas associated with this case, which included localization of the culprit lesions, a technically challenging surgical resection and subsequent medical management with cinacalcet when symptomatic hypercalcemia recurred during the third trimester. To our knowledge, this is only the third report of the successful use of cinacalcet during pregnancy, and the first case report of parathyromatosis presenting during pregnancy. CONCLUSION Cinacalcet was used safely and effectively during the third trimester of pregnancy to treat symptomatic hypercalcemia due to parathyromatosis.
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Affiliation(s)
- Kari L Edling
- Division of Endocrinology, Diabetes & Hypertension, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Stanley G Korenman
- Division of Endocrinology, Diabetes & Hypertension, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Carla Janzen
- Department of Obstetrics & Gynecology, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Marie Y Sohsman
- Department of Pathology & Laboratory Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Sophia K Apple
- Department of Pathology & Laboratory Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Sunita Bhuta
- Department of Pathology & Laboratory Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Michael W Yeh
- Division of Endocrinology, Diabetes & Hypertension, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, California
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24
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Achour I, Charfi S, Chaabouni MA, Chakroun A, Guermazi F, Hammami B, Ghorbel A. [Parathyromatosis: An uncommon cause of recurrent hyperparathyroidism]. Rev Med Interne 2016; 38:61-64. [PMID: 27083335 DOI: 10.1016/j.revmed.2016.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 03/15/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Parathyromatosis is a rare cause of recurrent hyperparathyroidism. It results from hyperfunctioning parathyroid tissue scattered throughout the thyroid bed region. CASE REPORT A 51-year-old man with a history of parathyroidectomy, presented 18 years later with recurrent primary hyperparathyroidism. Surgical exploration identified a single parathyroid gland. The act was completed by a central compartment dissection and ipsilateral lobectomy. The patient was free of recurrence after a one-year follow-up. CONCLUSION Parathyromatosis a rare cause of recurrent hyperparathyroidism. Its management is challenging. Extensive surgery is required with clearance of the central neck compartment and homolateral lobectomy. Medical therapy could be used to decrease parathormone level in recurrent parathyromatosis.
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Affiliation(s)
- I Achour
- Service ORL, chirurgie cervico-faciale, CHU Habib Bourguiba, 3029 Sfax, Tunisie.
| | - S Charfi
- Laboratoire d'anatomie et de cytologie pathologiques, CHU Habib Bourguiba, 3029 Sfax, Tunisie
| | - M A Chaabouni
- Service ORL, chirurgie cervico-faciale, CHU Habib Bourguiba, 3029 Sfax, Tunisie
| | - A Chakroun
- Service ORL, chirurgie cervico-faciale, CHU Habib Bourguiba, 3029 Sfax, Tunisie
| | - F Guermazi
- Service de médecine nucléaire, CHU Habib Bourguiba, 3029 Sfax, Tunisie
| | - B Hammami
- Service ORL, chirurgie cervico-faciale, CHU Habib Bourguiba, 3029 Sfax, Tunisie
| | - A Ghorbel
- Service ORL, chirurgie cervico-faciale, CHU Habib Bourguiba, 3029 Sfax, Tunisie
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Baker LJ, Gill AJ, Chan C, Lin BPC, Crawford BA. Parasitic thyroid nodules: cancer or not? Endocrinol Diabetes Metab Case Rep 2014; 2014:140027. [PMID: 24839549 PMCID: PMC4021484 DOI: 10.1530/edm-14-0027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 04/23/2014] [Indexed: 11/25/2022] Open
Abstract
In 2006, a 58-year-old woman presented with thyrotoxicosis. She had undergone left hemithyroidectomy 14 years before for a benign follicular adenoma. Ultrasound imaging demonstrated bilateral cervical lymphadenopathy with enhanced tracer uptake in the left lateral neck on a Technetium-99m uptake scan. Fine-needle aspiration biopsy of a left lateral neck node was insufficient for a cytological diagnosis; however, thyroglobulin (Tg) washings were strongly positive. The clinical suspicion was of functionally active metastatic thyroid cancer in cervical lymph nodes. A completion thyroidectomy and bilateral cervical lymph node dissection were performed. Histology demonstrated benign multinodularity in the right hemithyroid, with bilateral reactive lymphadenopathy and 24 benign hyperplastic thyroid nodules in the left lateral neck that were classified as parasitic thyroid nodules. As there had been a clinical suspicion of thyroid cancer, and the hyperplastic/parasitic thyroid tissue in the neck was extensive, the patient was given ablative radioactive iodine (3.7 GBq). After 2 years, a diagnostic radioactive iodine scan was clear and the serum Tg was undetectable. The patient has now been followed for 7 years with no evidence of recurrence. Archived tissue from a left lateral neck thyroid nodule has recently been analysed for BRAF V600E mutation, which was negative.
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Affiliation(s)
- Lauren J Baker
- Endocrinology Department Concord Hospital Sydney, New South Wales Australia
| | - Anthony J Gill
- Pathology Department Royal North Shore Hospital Sydney, New South Wales Australia ; Sydney Medical School, University of Sydney Sydney, New South Wales Australia
| | - Charles Chan
- Sydney Medical School, University of Sydney Sydney, New South Wales Australia ; Anatomical Pathology Department Concord Hospital Sydney, New South Wales? Australia
| | - Betty P C Lin
- Sydney Medical School, University of Sydney Sydney, New South Wales Australia ; Anatomical Pathology Department Concord Hospital Sydney, New South Wales? Australia
| | - Bronwyn A Crawford
- Endocrinology Department Concord Hospital Sydney, New South Wales Australia ; Sydney Medical School, University of Sydney Sydney, New South Wales Australia
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Scorza ABT, Moore AG, Terry M, Bricker LA. Secondary parathyromatosis in a patient with normal kidney function: review of diagnostic modalities and approaches to management. Endocr Pract 2013; 20:e4-7. [PMID: 24013979 DOI: 10.4158/ep13053.cr] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To present a patient with secondary parathyromatosis, a rare complication of parathyroidectomy, and to discuss issues currently pertinent to its diagnosis and management. METHODS Data were derived from clinical and pathologic observations obtained during patient care. RESULTS The index patient developed intractable hyperparathyroidism and hypercalcemia that has persisted after 4 surgical procedures and has remained largely resistant to medication, albeit with partial amelioration with combined bisphosphonate and cinacalcet. CONCLUSION Despite the rarity of this difficult complication of parathyroidectomy, its iatrogenic basis emphasizes a need for heightened awareness and caution among surgeons and endocrinologists. Herein we report an instance of intractable secondary parathyromatosis in a patient with normal kidney function, and we review current approaches to diagnosis and management.
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Affiliation(s)
- Anda B Tuncay Scorza
- Department of Internal Medicine, Western Michigan University School of Medicine, Kalamazoo, Michigan
| | - Andreea G Moore
- Department of Internal Medicine, Western Michigan University School of Medicine, Kalamazoo, Michigan
| | - Marisa Terry
- Department of Internal Medicine, Western Michigan University School of Medicine, Kalamazoo, Michigan
| | - Lee A Bricker
- Department of Internal Medicine, Western Michigan University School of Medicine, Kalamazoo, Michigan
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