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Substernal oxyphil parathyroid adenoma producing PTHrP with hypercalcemia and normal PTH level.

Gurrado A, Marzullo A, Lissidini G, Lippolis A, Rubini D, Lastilla G, Testini M - World J Surg Oncol (2008)

Bottom Line: In 1987, parathyroid-hormone-related peptide was isolated as a causative factor of humeral hypercalcemia of malignancy.The final histological diagnosis was oxyphil adenoma, positive for parathyroid-hormone-related peptide antigens.The parathyroid-hormone-related peptide should be considered not only in the presence of malignancy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Applications in Surgery of Innovative Technologies, University Medical School of Bari, Italy.angelagurrado@libero.it

ABSTRACT

Background: Parathyroid adenoma is the most common cause of primary hyperparathyroidism. Preoperative serum calcium and intact-parathyroid hormone levels are the most useful diagnostic parameters that allow differentiating primary hyperparathyroidism from non-parathyroid-dependent hypercalcemia. Parathyroidectomy is the definitive treatment for primary hyperparathyroidism. Approximately 5% of patients who underwent parathyroidectomy present with persistent or recurrent hyperparathyroidism due to ectopic localization of the adenoma. Functioning oxyphil parathyroid adenoma is an uncommon histological form, seldom causing primary hyperparathyroidism. Parathyroid adenoma with hypercalcemia exhibiting normal parathyroid hormone level is rare. An incidence of 5% to 33% has been documented in the literature; no etiologic explanation has been given. In 1987, parathyroid-hormone-related peptide was isolated as a causative factor of humeral hypercalcemia of malignancy. The presence of parathyroid-hormone-related peptide in parathyroid tissue under normal and pathological conditions has been described in the literature; however, its role in causing hyperparathyroidism has not yet been defined.

Case presentation: We present a case of persistent hypercalcemia with a normal level of intact-parathyroid hormone due to a substernal parathyroid adenoma, treated with radioguided parathyroidectomy. The final histological diagnosis was oxyphil adenoma, positive for parathyroid-hormone-related peptide antigens.

Conclusion: In clinical practice, this atypical biochemical presentation of primary hyperparathyroidism should be considered in the differential diagnosis of hypercalcemia. The parathyroid-hormone-related peptide should be considered not only in the presence of malignancy.

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Related in: MedlinePlus

Tc-99m-sestamibi Tc-99m sodium pertechnetate substraction image showed an area of intense uptake below the inferior pole of the left thyroid lobe, in the upper mediastinum, in the left median position and normal thyroid with homogenous radiopharmaceutical uptake (arrow).
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Figure 2: Tc-99m-sestamibi Tc-99m sodium pertechnetate substraction image showed an area of intense uptake below the inferior pole of the left thyroid lobe, in the upper mediastinum, in the left median position and normal thyroid with homogenous radiopharmaceutical uptake (arrow).

Mentions: Neck ultrasound was not significant; thorax CT scan revealed an encapsulated mass of 3 cm in the upper anterior mediastinum located behind the sternoclavicular junction (Figure 1). Tc-99m sodium pertechnetate/Tc-99m-sestamibi parathyroid dual-phase scintigraphy with subtraction image technique revealed the mass to be an ectopic parathyroid adenoma at the level of the left sternoclavicular junction (Figure 2).


Substernal oxyphil parathyroid adenoma producing PTHrP with hypercalcemia and normal PTH level.

Gurrado A, Marzullo A, Lissidini G, Lippolis A, Rubini D, Lastilla G, Testini M - World J Surg Oncol (2008)

Tc-99m-sestamibi Tc-99m sodium pertechnetate substraction image showed an area of intense uptake below the inferior pole of the left thyroid lobe, in the upper mediastinum, in the left median position and normal thyroid with homogenous radiopharmaceutical uptake (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2279131&req=5

Figure 2: Tc-99m-sestamibi Tc-99m sodium pertechnetate substraction image showed an area of intense uptake below the inferior pole of the left thyroid lobe, in the upper mediastinum, in the left median position and normal thyroid with homogenous radiopharmaceutical uptake (arrow).
Mentions: Neck ultrasound was not significant; thorax CT scan revealed an encapsulated mass of 3 cm in the upper anterior mediastinum located behind the sternoclavicular junction (Figure 1). Tc-99m sodium pertechnetate/Tc-99m-sestamibi parathyroid dual-phase scintigraphy with subtraction image technique revealed the mass to be an ectopic parathyroid adenoma at the level of the left sternoclavicular junction (Figure 2).

Bottom Line: In 1987, parathyroid-hormone-related peptide was isolated as a causative factor of humeral hypercalcemia of malignancy.The final histological diagnosis was oxyphil adenoma, positive for parathyroid-hormone-related peptide antigens.The parathyroid-hormone-related peptide should be considered not only in the presence of malignancy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Applications in Surgery of Innovative Technologies, University Medical School of Bari, Italy.angelagurrado@libero.it

ABSTRACT

Background: Parathyroid adenoma is the most common cause of primary hyperparathyroidism. Preoperative serum calcium and intact-parathyroid hormone levels are the most useful diagnostic parameters that allow differentiating primary hyperparathyroidism from non-parathyroid-dependent hypercalcemia. Parathyroidectomy is the definitive treatment for primary hyperparathyroidism. Approximately 5% of patients who underwent parathyroidectomy present with persistent or recurrent hyperparathyroidism due to ectopic localization of the adenoma. Functioning oxyphil parathyroid adenoma is an uncommon histological form, seldom causing primary hyperparathyroidism. Parathyroid adenoma with hypercalcemia exhibiting normal parathyroid hormone level is rare. An incidence of 5% to 33% has been documented in the literature; no etiologic explanation has been given. In 1987, parathyroid-hormone-related peptide was isolated as a causative factor of humeral hypercalcemia of malignancy. The presence of parathyroid-hormone-related peptide in parathyroid tissue under normal and pathological conditions has been described in the literature; however, its role in causing hyperparathyroidism has not yet been defined.

Case presentation: We present a case of persistent hypercalcemia with a normal level of intact-parathyroid hormone due to a substernal parathyroid adenoma, treated with radioguided parathyroidectomy. The final histological diagnosis was oxyphil adenoma, positive for parathyroid-hormone-related peptide antigens.

Conclusion: In clinical practice, this atypical biochemical presentation of primary hyperparathyroidism should be considered in the differential diagnosis of hypercalcemia. The parathyroid-hormone-related peptide should be considered not only in the presence of malignancy.

Show MeSH
Related in: MedlinePlus