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Lau JHYH, Ng KK, Wong WC, Kung BT. Giant parathyroid adenoma and hungry bone syndrome in MEN1 syndrome: A case report. Radiol Case Rep 2024; 19:2959-2964. [PMID: 38737174 PMCID: PMC11087690 DOI: 10.1016/j.radcr.2024.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/03/2024] [Accepted: 04/08/2024] [Indexed: 05/14/2024] Open
Abstract
An 18-year-old male with multiple endocrine neoplasm type 1 (MEN1) syndrome presented with hyperparathyroidism. Parathyroidectomy was performed. Patient complained of bone pain afterwards, multiple imaging modalities revealed features of osteitis fibrosa cystica and biochemical profile showed features of hungry bone syndrome. Incidental suspicious pancreatic lesion was initially revealed by 18F-FDG PET/CT scan while MRI further characterized the possibility of insulinoma. Ultimately, the patient was diagnosed of MEN1 syndrome by genetic test. This case report demonstrates the utilization of various imaging modalities such as ultrasound, Tc99m-sestamibi parathyroid scintigraphy, bone scintigraphy, CT, PET/CT and MRI, which leads to ultimately the diagnosis of MEN1 syndrome.
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Affiliation(s)
| | - Koon Kiu Ng
- Nulcear Medicine Unit, Queen Elizabeth Hospital, Hong Kong
| | - Wai Chung Wong
- Nulcear Medicine Unit, Queen Elizabeth Hospital, Hong Kong
| | - Boom Ting Kung
- Nulcear Medicine Unit, Queen Elizabeth Hospital, Hong Kong
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Martínez-Loya C, Granados-Gutiérrez DE, Torrens-Chacón A, Rodríguez-Luna DA, Frayre-García ZE, Villegas-Vázquez L, Enríquez-Sánchez LB. Bilateral giant parathyroid adenoma and hungry bone syndrome: a case report. J Med Case Rep 2023; 17:373. [PMID: 37653552 PMCID: PMC10472692 DOI: 10.1186/s13256-023-04102-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 07/26/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND There is some evidence supporting the idea that double parathyroid adenomas represent a different entity from multiglandular hyperplasia; however, the distinction among them is not straightforward. CASE PRESENTATION We described a case of primary hyperparathyroidism (PHPT) with pronounced clinical manifestations, caused by a bilateral giant parathyroid adenoma. A 34-year-old Hispanic/Latino male was diagnosed with PHPT caused by two giant parathyroid adenomas. The preoperative tests were neck ultrasound and computed tomography scan (CT-scan), showing two masses in the territory of parathyroid glands, bilaterally distributed (right was 31 × 18 × 19 mm and the left was 38 × 15 × 14 mm); sestamibi scan was not available. Parathyroid hormone (PTH) was highly elevated. Multiple complications of PHPT were present, such as bone lytic lesions, renal and pancreatic calcifications, and cardiovascular disease, the latter of which is an overlooked complication of PHPT. Multiple endocrine neoplasia 1 and 2 (MEN 1/2) were ruled out by the absence of clinical, biochemical, and radiological findings in other endocrine glands. The patient underwent subtotal parathyroidectomy with an intraoperative histopathological study; both intraoperative and definitive histopathology results were consistent with parathyroid adenomas; afterward, adequate suppression of PTH was assured, and later on, the patient presented hungry bone syndrome (HBS). CONCLUSIONS The diagnosis of double parathyroid adenomas is difficult. Regarding the similarities between multiglandular hyperplasia and parathyroid adenomas, this case report contributes to the further distinction between these two clinical entities. This case report also represents, in particular, the challenge of difficult diagnosis in places with limited resources, such as developing countries.
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Affiliation(s)
- Carolina Martínez-Loya
- Departamento de Investigación, Universidad Autonóma de Chihuahua, Facultad de Medicina y Ciencias Biomédicas, Nuevo Campus Universitario, 31125, Chihuahua, Mexico.
| | - Dalai E Granados-Gutiérrez
- Departamento de Cirugía, Hospital Central del Estado, Antonio Rosales 33000, Obrera, 31350, Chihuahua, Mexico
| | - Anagabriela Torrens-Chacón
- Departamento de Cirugía, Hospital Central del Estado, Antonio Rosales 33000, Obrera, 31350, Chihuahua, Mexico
| | - David A Rodríguez-Luna
- Departamento de Medicina Interna, Hospital Central del Estado, Antonio Rosales 33000, Obrera, 31350, Chihuahua, Mexico
| | - Zabdy E Frayre-García
- Departamento de Medicina Interna, Hospital Central del Estado, Antonio Rosales 33000, Obrera, 31350, Chihuahua, Mexico
| | - Leonela Villegas-Vázquez
- Médico Interno de Pregrado, Hospital Central del Estado, Antonio Rosales 33000, Obrera, 31350, Chihuahua, Mexico
| | - Luis B Enríquez-Sánchez
- Departamento de Investigación, Universidad Autonóma de Chihuahua, Facultad de Medicina y Ciencias Biomédicas, Nuevo Campus Universitario, 31125, Chihuahua, Mexico
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de Jong MC, Jamal K, Morley S, Beale T, Chung T, Jawad S, Hurel S, Simpson H, Srirangalingam U, Baldeweg SE, Rozalén García V, Otero S, Shawky M, Abdel-Aziz TE, Kurzawinski TR. The use of computed tomography as a first-line imaging modality in patients with primary hyperparathyroidism. Hormones (Athens) 2021; 20:499-506. [PMID: 32405929 DOI: 10.1007/s42000-020-00205-x] [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: 02/13/2020] [Accepted: 04/26/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The success of minimally invasive parathyroidectomy (MIP) relies on accurate localization of the abnormal parathyroid glands. Concordant findings on ultrasound (US) and 99mTc-scintigraphy (sestamibi) are currently considered the 'gold standard'. Computed tomography (CT) has also recently been used in preoperative planning. We sought to assess the accuracy of CT for localization of abnormal parathyroid glands in such patients. METHODS An audit of 75 patients with primary hyperparathyroidism (PHPT) who underwent neck US and CT between 2017 and 2019 at our center as their first-line imaging. RESULTS All 75 patients underwent US and CT and 54 (72.0%) also had sestamibi. CT alone identified a potential target in all patients, of which the location was correct in 63 (84.0%). The overall combined sensitivity of US and CT was 88% (95% CI 78-94) and was higher than the combined sensitivity of US and sestamibi (65% [95% CI 53-76]; p < 0.001). Twenty-one patients (28.0%) had an ectopic gland, and the sensitivity of US and CT was 86% (95% CI 64-96) versus US and sestamibi (57% [95% CI 34-77]; p = 0.016). For adenomas < 1.0 g (n = 36; 48%), the accuracy of CT was 81% (95% CI 64-91) compared with 62% (95% CI 44-77) for US and sestamibi (p = 0.04). The correct preoperative diagnosis of multiglandular disease (n = 9; 12%) seemed to be the most difficult, with similar accuracy for US and sestamibi (40% [95% CI 14-73]) and US and CT (50% [95% CI 20-80]) (p > 0.99). CONCLUSION The combination of US and CT was able to correctly identify the location of the abnormal parathyroid in 88% of patients and, in comparison with US and sestamibi, had better diagnostic accuracy, especially for smaller and ectopic adenomas. This finding suggests that US and CT could be considered as a first-line imaging modality in patients with PHPT considered for MIP.
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Affiliation(s)
- Mechteld C de Jong
- Centre for Endocrine Surgery, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK.
| | - K Jamal
- Centre for Endocrine Surgery, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - S Morley
- Department of Radiology, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - T Beale
- Department of Radiology, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - T Chung
- Department of Endocrinology, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - S Jawad
- Department of Radiology, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - S Hurel
- Department of Endocrinology, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - H Simpson
- Department of Endocrinology, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - U Srirangalingam
- Department of Endocrinology, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - S E Baldeweg
- Department of Endocrinology, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - V Rozalén García
- Centre for Endocrine Surgery, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - S Otero
- Department of Radiology, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - M Shawky
- Centre for Endocrine Surgery, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - T E Abdel-Aziz
- Centre for Endocrine Surgery, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - T R Kurzawinski
- Centre for Endocrine Surgery, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
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Lenherr-Taube N, Lam CK, Vali R, Shammas A, Campisi P, Zawawi F, Somers GR, Stimec J, Mete O, Wong AK, Sochett E. Severe Primary Hyperparathyroidism Caused by Parathyroid Carcinoma in a 13-Year-Old Child; Novel Findings From HRpQCT. JBMR Plus 2020; 4:e10324. [PMID: 32161840 PMCID: PMC7059826 DOI: 10.1002/jbm4.10324] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/12/2019] [Accepted: 12/03/2019] [Indexed: 12/15/2022] Open
Abstract
Primary hyperparathyroidism is a condition that occurs infrequently in children. Parathyroid carcinoma, as the underlying cause of hyperparathyroidism in this age group, is extraordinarily rare, with only a few cases reported in the literature. We present a 13-year-old boy with musculoskeletal pain who was found to have brown tumors from primary hyperparathyroidism caused by parafibromin-immunodeficient parathyroid carcinoma. Our patient had no clinical, biochemical, or radiographic evidence of pituitary adenomas, pancreatic tumors, thyroid tumors, pheochromocytoma, jaw tumors, renal abnormalities, or testicular lesions. Germline testing for AP2S1, CASR, CDC73/HRPT2, CDKN1B, GNA11, MEN1, PTH1R, RET, and the GCM2 gene showed no pathological variants, and a microarray of CDC73/HRPT2 did not reveal deletion or duplication. He was managed with i.v. fluids, calcitonin, pamidronate, and denosumab prior to surgery to stabilize hypercalcemia. After removal of a single parathyroid tumor, he developed severe hungry bone syndrome and required 3 weeks of continuous i.v. calcium infusion, in addition to oral calcium and activated vitamin D. Histopathological examination identified an angioinvasive parathyroid carcinoma with global loss of parafibromin (protein encoded by CDC73/HRPT2).HRpQCT and DXA studies were obtained prior to surgery and 18-months postsurgery. HRpQCT showed a resolution of osteolytic lesions combined with structural improvement of cortical porosity and an increase in both cortical thickness and density compared with levels prior to treatment. These findings highlight the added value of HRpQCT in primary hyperparathyroidism. In addition to our case, we have provided a review of the published cases of parathyroid cancer in children. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Nina Lenherr-Taube
- Department of Pediatrics, Division of Endocrinology Toronto Canada.,University of Toronto Toronto Canada
| | - Carol Kl Lam
- Department of Pediatrics, Division of Endocrinology Toronto Canada.,University of Toronto Toronto Canada
| | - Reza Vali
- University of Toronto Toronto Canada.,Department of Diagnostic Imaging, Division of Nuclear Medicine Hospital for Sick Children Toronto Canada
| | - Amer Shammas
- University of Toronto Toronto Canada.,Department of Diagnostic Imaging, Division of Nuclear Medicine Hospital for Sick Children Toronto Canada
| | - Paolo Campisi
- University of Toronto Toronto Canada.,Department of Otolaryngology - Head & Neck Surgery Hospital for Sick Children Toronto Canada
| | - Faisal Zawawi
- University of Toronto Toronto Canada.,Department of Otolaryngology - Head & Neck Surgery Hospital for Sick Children Toronto Canada
| | - Gino R Somers
- University of Toronto Toronto Canada.,Department of Laboratory Medicine & Pathology Hospital for Sick Children Toronto Canada
| | - Jennifer Stimec
- University of Toronto Toronto Canada.,Department of Diagnostic Imaging Hospital for Sick Children Toronto Canada
| | - Ozgur Mete
- University of Toronto Toronto Canada.,Department of Pathology University Health Network, Princess Margaret Cancer Centre Toronto Canada
| | - Andy Ko Wong
- University of Toronto Toronto Canada.,Joint Department of Medical Imaging, Toronto General Research Institute University Health Network Toronto Canada.,Department of Epidemiology Dalla Lana School of Public Health Toronto Canada
| | - Etienne Sochett
- Department of Pediatrics, Division of Endocrinology Toronto Canada.,University of Toronto Toronto Canada
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