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Functional parathyroid cyst in a patient with systemic lupus erythematosus: a case report.

Jiang J, Zhang M, He R, Shen M, Liu W - Endocrinol Diabetes Metab Case Rep (2015)

Bottom Line: In this case, no evidence for potential pathogenic association between parathyroid cyst and SLE was uncovered.However, the recognition of this association is very important because the therapeutical strategy is completely different.Operative management is usually straightforward and alleviates symptoms and any biochemical abnormalities caused by the cyst.

View Article: PubMed Central - PubMed

Affiliation: Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University , Shanghai, 200032 , People's Republic of China.

ABSTRACT

Unlabelled: Functional parathyroid cysts are a rare cause of primary hyperparathyroidism and are often mistaken for thyroid cysts. Systemic lupus erythematosus (SLE) is also a very rare cause of hypercalcemia. We report the case of a 62-year-old woman, who was diagnosed with SLE 30 years ago, presenting with clinical and biochemical features of primary hyperparathyroidism. Laboratory investigation revealed increased serum calcium and parathyroid hormone (PTH) levels; neck ultrasonography (USG) revealed 40×34×26 mm cystic mass in the left lobe of thyroid gland. PTH level in the cysts was >2500 pg/ml, determined by USG-guided fine-needle aspiration (FNA). In this case, no evidence for potential pathogenic association between parathyroid cyst and SLE was uncovered. However, the recognition of this association is very important because the therapeutical strategy is completely different. Operative management is usually straightforward and alleviates symptoms and any biochemical abnormalities caused by the cyst.

Learning points: Functional parathyroid cysts are the rare cause of primary hyperparathyroidism and are often mistaken for thyroid cysts.SLE is also a very rare cause of hypercalcemia.Ultrasound-guided FNA of cystic fluid with assay for PTH level is an accurate method of differentiating parathyroid cyst from thyroid cyst.Appropriate management of functional parathyroid cysts is surgical excision.

No MeSH data available.


Related in: MedlinePlus

99mTc-MIBI scintigraphy demonstrated focal accumulation and persistent uptake of radiotracers at the wall of the cystic mass. (A and B) Early images of 99mTc-MI; Panels C and D: delayed images of 99mTc-MIBI.
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fig3: 99mTc-MIBI scintigraphy demonstrated focal accumulation and persistent uptake of radiotracers at the wall of the cystic mass. (A and B) Early images of 99mTc-MI; Panels C and D: delayed images of 99mTc-MIBI.

Mentions: X-ray showed subperiosteal bone resorption in the middle and distal phalanges of the fingers. But no sign of osteoporosis was observed in skull, neck of femur, or lumbar spine. Spot-like shadows were seen at both lower lobes of the lungs on X-ray. Ultrasonography (USG) scan revealed a 40×34×26 mm cystic mass in the left lobe of thyroid gland (Fig. 1). High-intensity images on both T1 and T2-weighted magnetic resonance imaging (MRI) suggested that the cystic area was composed of liquid (Fig. 2). And USG scan of kidney and urinary tract revealed nephrolithiasis in the left kidney. Parathyroid scintigraphy using 99mTc-MIBI showed intense accumulation and persistent uptake of radioactivities by the wall of the cyst (Fig. 3). Fine-needle aspiration (FNA) of the cyst was performed under ultrasound guidance, and 20 ml of bloody fluid was removed. The aspirate's PTH level was >2500 pg/ml. The mass shrinked immediately after aspiration, but reemerged overnight. Cytological analysis revealed a few macrophages and benign-appearing, follicular cells.


Functional parathyroid cyst in a patient with systemic lupus erythematosus: a case report.

Jiang J, Zhang M, He R, Shen M, Liu W - Endocrinol Diabetes Metab Case Rep (2015)

99mTc-MIBI scintigraphy demonstrated focal accumulation and persistent uptake of radiotracers at the wall of the cystic mass. (A and B) Early images of 99mTc-MI; Panels C and D: delayed images of 99mTc-MIBI.
© Copyright Policy - license
Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC4315945&req=5

fig3: 99mTc-MIBI scintigraphy demonstrated focal accumulation and persistent uptake of radiotracers at the wall of the cystic mass. (A and B) Early images of 99mTc-MI; Panels C and D: delayed images of 99mTc-MIBI.
Mentions: X-ray showed subperiosteal bone resorption in the middle and distal phalanges of the fingers. But no sign of osteoporosis was observed in skull, neck of femur, or lumbar spine. Spot-like shadows were seen at both lower lobes of the lungs on X-ray. Ultrasonography (USG) scan revealed a 40×34×26 mm cystic mass in the left lobe of thyroid gland (Fig. 1). High-intensity images on both T1 and T2-weighted magnetic resonance imaging (MRI) suggested that the cystic area was composed of liquid (Fig. 2). And USG scan of kidney and urinary tract revealed nephrolithiasis in the left kidney. Parathyroid scintigraphy using 99mTc-MIBI showed intense accumulation and persistent uptake of radioactivities by the wall of the cyst (Fig. 3). Fine-needle aspiration (FNA) of the cyst was performed under ultrasound guidance, and 20 ml of bloody fluid was removed. The aspirate's PTH level was >2500 pg/ml. The mass shrinked immediately after aspiration, but reemerged overnight. Cytological analysis revealed a few macrophages and benign-appearing, follicular cells.

Bottom Line: In this case, no evidence for potential pathogenic association between parathyroid cyst and SLE was uncovered.However, the recognition of this association is very important because the therapeutical strategy is completely different.Operative management is usually straightforward and alleviates symptoms and any biochemical abnormalities caused by the cyst.

View Article: PubMed Central - PubMed

Affiliation: Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University , Shanghai, 200032 , People's Republic of China.

ABSTRACT

Unlabelled: Functional parathyroid cysts are a rare cause of primary hyperparathyroidism and are often mistaken for thyroid cysts. Systemic lupus erythematosus (SLE) is also a very rare cause of hypercalcemia. We report the case of a 62-year-old woman, who was diagnosed with SLE 30 years ago, presenting with clinical and biochemical features of primary hyperparathyroidism. Laboratory investigation revealed increased serum calcium and parathyroid hormone (PTH) levels; neck ultrasonography (USG) revealed 40×34×26 mm cystic mass in the left lobe of thyroid gland. PTH level in the cysts was >2500 pg/ml, determined by USG-guided fine-needle aspiration (FNA). In this case, no evidence for potential pathogenic association between parathyroid cyst and SLE was uncovered. However, the recognition of this association is very important because the therapeutical strategy is completely different. Operative management is usually straightforward and alleviates symptoms and any biochemical abnormalities caused by the cyst.

Learning points: Functional parathyroid cysts are the rare cause of primary hyperparathyroidism and are often mistaken for thyroid cysts.SLE is also a very rare cause of hypercalcemia.Ultrasound-guided FNA of cystic fluid with assay for PTH level is an accurate method of differentiating parathyroid cyst from thyroid cyst.Appropriate management of functional parathyroid cysts is surgical excision.

No MeSH data available.


Related in: MedlinePlus