DOI: http://dx.doi.org/10.18203/2349-2902.isj20214769

Left parathyroid adenoma with features of brown tumor, incidental finding: a case report

Disha Bhandary, Rithin Suvarna, Bhaskara Bhandary

Abstract


Primary hyperparathyroidism (PHPT) occurs in a setting of excessive parathyroid hormone (PTH) secretion with an autonomous parathyroid gland which resulting in hypercalcemia. Cases of parathyroid adenoma are rare, PTH is a chief regulator of calcium homeostasis in the human body. PHPT could be caused by solitary adenomas, hyperplasia, multiple adenomas and carcinomas. A 35-year-old female who came in with complaints of left hip pain past 1 month which aggravated since 1 week, with previous medical history of hyperthyroidism. Laboratory and biochemical findings suggested features of PHPT. She underwent left parathyroid excision with subtotal thyroidectomy. Histopathology analysis revealed features of parathyroid adenoma with eosinophilic to clear cytoplasm, few foci with oxyphilic nodules. Patient showed significant fall in PTH levels after tumor excision and is being discharged 5th day after surgery. PHPT occurs at any age, but it is most commonly seen in people over the age of 50 years and postmenopausal women. The current presentation of PHPT shifts from the classical symptomatic form to the asymptomatic form. parathyroidectomy is still the treatment of choice for both symptomatic and asymptomatic forms. Parathyroid adenoma has an excellent prognosis with surgical treatment.


Keywords


Parathyroid adenoma, Hyperthyroidism, Serum calcium, Hyperparathyroidism

Full Text:

PDF

References


Fisher S, Wishart G. Hyperparathyroidism and hypocalcemia. Surgery. 2007;25:487-91.

Gomes EM, Nunes RC, Lacativa PG, Almeida MH, Franco FM, et al. Ectopic and extranumerary parathyroid glands location in patients with hyperparathyroidism secondary to end stage renal disease. Acta Cir Bras. 2007;22:105-9.

Kumar R, Thompson JR. The regulation of parathyroid hormone secretion and synthesis. J Am Soc Nephrol. 2011;22:216-24.

Bruder JM, Gruise TA, Mundy GR. Mineral metabolism. In Endocrinology and Metabolism. New York: McGraw-Hill. 2001;1079-179.

Jacob PM, Sukumar GC, Nair A, Thomas S. Parathyroid adenoma with necrotizing granulomatous inflammation presenting as primary hyperparathyroidism. Endocr Pathol. 2005;16:157-60.

Clark MJ, Pellitteri PK. Assessing the impact of low baseline parathyroid hormone levels on surgical treatment of primary hyperparathyroidism. Laryngoscope. 2009;119:1100-5.

Repplinger D, Schaefer S, Chen H, Sippel RS. Neurocognitive dysfunction: a predictor of parathyroid hyperplasia. Surgery. 2009;146:1138-43.

Jacobs TP, Bilezikian JP. Clinical review: Rare causes of hypercalcemia. J Clin Endocrinol Metab. 2005;90:6316-22.

Taguchi K, Makimoto K, Nagai S, Izumi T, Yamabe H. Cystic parathyroid adenoma with co-existent sarcoid granulomas. Arch Otorhinolaryngol. 1987;243:392-4.

Bruder JM, Gruise TA, Mundy GR. Mineral metabolism. In Endocrinology and Metabolism. McGraw-Hill. 2001;1079-179.

Kar DK, Agarwal G, Mehta B, Agarwal J, Gupta RK, Dhole TN, Mishra SK. Tuberculous granulomatous inflammation associated with adenoma of parathyroid gland manifesting as primary hyperparathyroidism. Endocr Pathol. 2001;12:355-9.

Taguchi K, Makimoto K, Nagai S, Izumi T, Yamabe H. Cystic parathyroid adenoma with co-existent sarcoid granulomas. Arch Otorhinolaryngol. 1987;243:392-4.

Ruda JM, Hollenbeak CS, Stack BC. A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003. Otolaryngol Head Neck Surg. 2005;132:359-72.

Shane E. Clinical review 122: Parathyroid carcinoma. J Clin Endocrinol Metab. 2001;86:485-93.

Repplinger D, Schaefer S, Chen H, Sippel RS. Neurocognitive dysfunction: a predictor of parathyroid hyperplasia. Surgery. 2009;146:1138-43.