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A Rare Presentation of Primary Hyperparathyroidism with Concurrent Aldosterone-Producing Adrenal Carcinoma.

Molina-Ayala M, Ramírez-Rentería C, Manguilar-León A, Paúl-Gaytán P, Ferreira-Hermosillo A - Case Rep Endocrinol (2015)

Bottom Line: A Tc99m-MIBI scintigraphy showed an abnormally increased tracer uptake in the right superior parathyroid and abdominal computed tomography confirmed a left adrenal tumor of 20 cm.The patient underwent parathyroidectomy and adrenalectomy with final pathology reports of parathyroid hyperplasia and adrenal carcinoma with biochemical remission of both endocrinopathies.He was started on chemotherapy, but the patient developed a frontal cortex and an arm metastasis and finally died less than one year later.

View Article: PubMed Central - PubMed

Affiliation: Endocrinology Department, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, IMSS, Cuauhtémoc 330, Colonia Doctores, 06720 Mexico City, DF, Mexico.

ABSTRACT
Aldosterone-producing adrenocortical carcinomas are an extremely rare cause of hyperaldosteronism (<1%). Coexistence of different endocrine tumors warrants additional screening for multiple endocrine neoplasia syndromes, especially in young patients with large or malignant masses. We present the case of a 40-year-old man with a history of hypertension that presented with an incidental left adrenal tumor during an ultrasound performed for nephrolithiasis. Biochemical assessment showed a mildly elevated calcium (11.1 mg/dL), high parathyroid hormone, and a plasma aldosterone concentration/plasma renin activity ratio of 124.5 (normal < 30), compatible with primary hyperparathyroidism with a concomitant primary hyperaldosteronism. A Tc99m-MIBI scintigraphy showed an abnormally increased tracer uptake in the right superior parathyroid and abdominal computed tomography confirmed a left adrenal tumor of 20 cm. The patient underwent parathyroidectomy and adrenalectomy with final pathology reports of parathyroid hyperplasia and adrenal carcinoma with biochemical remission of both endocrinopathies. He was started on chemotherapy, but the patient developed a frontal cortex and an arm metastasis and finally died less than one year later.

No MeSH data available.


Related in: MedlinePlus

Adrenal CT Image shows a tumor on the left adrenal gland of 202 × 127 × 202 mm (white arrow) that displaces ipsilateral kidney and renal cysts.
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fig2: Adrenal CT Image shows a tumor on the left adrenal gland of 202 × 127 × 202 mm (white arrow) that displaces ipsilateral kidney and renal cysts.

Mentions: After biochemical confirmation of hyperparathyroidism, a Tc99m-MIBI scintigraphy showed an abnormally increased tracer uptake in the right superior parathyroid (Figure 1). The abdominal CT scan confirmed the presence of a giant left adrenal tumor (20 × 13 × 20 cm) (Figure 2). Despite the kidney displacement due to the large tumor, there was no evidence of arterial stenosis. Based on these findings, a diagnosis of primary hyperparathyroidism associated with an aldosterone-producing tumor (highly suspicious of malignancy) was made.


A Rare Presentation of Primary Hyperparathyroidism with Concurrent Aldosterone-Producing Adrenal Carcinoma.

Molina-Ayala M, Ramírez-Rentería C, Manguilar-León A, Paúl-Gaytán P, Ferreira-Hermosillo A - Case Rep Endocrinol (2015)

Adrenal CT Image shows a tumor on the left adrenal gland of 202 × 127 × 202 mm (white arrow) that displaces ipsilateral kidney and renal cysts.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4487930&req=5

fig2: Adrenal CT Image shows a tumor on the left adrenal gland of 202 × 127 × 202 mm (white arrow) that displaces ipsilateral kidney and renal cysts.
Mentions: After biochemical confirmation of hyperparathyroidism, a Tc99m-MIBI scintigraphy showed an abnormally increased tracer uptake in the right superior parathyroid (Figure 1). The abdominal CT scan confirmed the presence of a giant left adrenal tumor (20 × 13 × 20 cm) (Figure 2). Despite the kidney displacement due to the large tumor, there was no evidence of arterial stenosis. Based on these findings, a diagnosis of primary hyperparathyroidism associated with an aldosterone-producing tumor (highly suspicious of malignancy) was made.

Bottom Line: A Tc99m-MIBI scintigraphy showed an abnormally increased tracer uptake in the right superior parathyroid and abdominal computed tomography confirmed a left adrenal tumor of 20 cm.The patient underwent parathyroidectomy and adrenalectomy with final pathology reports of parathyroid hyperplasia and adrenal carcinoma with biochemical remission of both endocrinopathies.He was started on chemotherapy, but the patient developed a frontal cortex and an arm metastasis and finally died less than one year later.

View Article: PubMed Central - PubMed

Affiliation: Endocrinology Department, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, IMSS, Cuauhtémoc 330, Colonia Doctores, 06720 Mexico City, DF, Mexico.

ABSTRACT
Aldosterone-producing adrenocortical carcinomas are an extremely rare cause of hyperaldosteronism (<1%). Coexistence of different endocrine tumors warrants additional screening for multiple endocrine neoplasia syndromes, especially in young patients with large or malignant masses. We present the case of a 40-year-old man with a history of hypertension that presented with an incidental left adrenal tumor during an ultrasound performed for nephrolithiasis. Biochemical assessment showed a mildly elevated calcium (11.1 mg/dL), high parathyroid hormone, and a plasma aldosterone concentration/plasma renin activity ratio of 124.5 (normal < 30), compatible with primary hyperparathyroidism with a concomitant primary hyperaldosteronism. A Tc99m-MIBI scintigraphy showed an abnormally increased tracer uptake in the right superior parathyroid and abdominal computed tomography confirmed a left adrenal tumor of 20 cm. The patient underwent parathyroidectomy and adrenalectomy with final pathology reports of parathyroid hyperplasia and adrenal carcinoma with biochemical remission of both endocrinopathies. He was started on chemotherapy, but the patient developed a frontal cortex and an arm metastasis and finally died less than one year later.

No MeSH data available.


Related in: MedlinePlus