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Recurrent hyperparathyroidism due to proliferation of autotransplanted parathyroid tissue in a multiple endocrine neoplasia type 2A patient

View Article: PubMed Central - PubMed

ABSTRACT

About 20%–30% of all cases of multiple endocrine neoplasia type 2A (MEN 2A) is accompanied by primary hyperparathyroidism. These patients undergo parathyroidectomy and, if needed, autotransplantation. In rare cases, autotransplanted parathyroid tissues can cause hypoparathyroidism due to failure of transplantation or hyperparathyroidism due to proliferation of the transplanted tissue. A 68-year-old female with MEN 2A underwent left adrenalectomy for pheochromocytoma 15 years prior to presentation and total thyroidectomy, central and right lateral neck lymph node dissection, and subtotal parathyroidectomy with autotransplantation for medullary thyroid cancer and primary hyperparathyroidism 6 years previous. Recently, a doubtful parathyroid adenoma was detected in the left sternocleidomastoid muscle on ultrasonography and on an additional sestamibi scan. The mass was excised and histologically confirmed as parathyroid adenoma. This is a very rare case, and it suggests that long-term regular monitoring of serum calcium and intact parathyroid hormone levels is necessary after parathyroid autotransplantation.

No MeSH data available.


Related in: MedlinePlus

Ultrasonographic image of a 68-year-old female with recurrent hyperparathyroidism. (A) A 1.3 cm × 0.6 cm round hypoechoic nodule in the left sternocleidomastoid muscle. (B) The nodule was well supplied with vessels according to Doppler flow mode.
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Figure 2: Ultrasonographic image of a 68-year-old female with recurrent hyperparathyroidism. (A) A 1.3 cm × 0.6 cm round hypoechoic nodule in the left sternocleidomastoid muscle. (B) The nodule was well supplied with vessels according to Doppler flow mode.

Mentions: A 68-year-old female with MEN 2A had a family history of thyroidectomy for medullary thyroid cancer (Fig. 1). In addition, 15 years prior, she underwent left adrenalectomy for pheochromocytoma; 6 years prior, she underwent total thyroidectomy, central and right lateral neck lymph node dissection, and subtotal parathyroidectomy with autotransplantation in the left sternocleidomastoid muscle for medullary thyroid cancer and primary hyperparathyroidism. At this time, the serum calcium level was 10.7 mg/dL (normal range, 8.6–10.2 mg/dL) and the parathyroid glands were enlarged bilaterally; the intact parathyroid hormone (iPTH) level was not determined. After the surgery, follow-up serum calcium and iPTH levels were within the normal ranges. Five years later, her iPTH level increased (113.10 pg/mL; normal range, 15–65 pg/mL), and she experienced hypercalcemia (11.1 mg/dL) with elevated iPTH (122.30 pg/mL) in the next year. On ultrasonography, a 1.3 × 0.6-cm-sized ovoid suspicious mass was detected in the left sternocleidomastoid muscle on the level 3 or 4 (Fig. 2). A core needle biopsy on the mass confirmed it to be parathyroid tissue. On additional sestamibi scan, a focal hot uptake was observed at the left neck (Fig. 3). Therefore, she underwent mass excision. A 1.6-cm-sized, well-circumscribed mass was detected in the sternal part of the left sternocleidomastoid muscle, excised (Fig. 4), and histologically confirmed to be parathyroid adenoma.


Recurrent hyperparathyroidism due to proliferation of autotransplanted parathyroid tissue in a multiple endocrine neoplasia type 2A patient
Ultrasonographic image of a 68-year-old female with recurrent hyperparathyroidism. (A) A 1.3 cm × 0.6 cm round hypoechoic nodule in the left sternocleidomastoid muscle. (B) The nodule was well supplied with vessels according to Doppler flow mode.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5016605&req=5

Figure 2: Ultrasonographic image of a 68-year-old female with recurrent hyperparathyroidism. (A) A 1.3 cm × 0.6 cm round hypoechoic nodule in the left sternocleidomastoid muscle. (B) The nodule was well supplied with vessels according to Doppler flow mode.
Mentions: A 68-year-old female with MEN 2A had a family history of thyroidectomy for medullary thyroid cancer (Fig. 1). In addition, 15 years prior, she underwent left adrenalectomy for pheochromocytoma; 6 years prior, she underwent total thyroidectomy, central and right lateral neck lymph node dissection, and subtotal parathyroidectomy with autotransplantation in the left sternocleidomastoid muscle for medullary thyroid cancer and primary hyperparathyroidism. At this time, the serum calcium level was 10.7 mg/dL (normal range, 8.6–10.2 mg/dL) and the parathyroid glands were enlarged bilaterally; the intact parathyroid hormone (iPTH) level was not determined. After the surgery, follow-up serum calcium and iPTH levels were within the normal ranges. Five years later, her iPTH level increased (113.10 pg/mL; normal range, 15–65 pg/mL), and she experienced hypercalcemia (11.1 mg/dL) with elevated iPTH (122.30 pg/mL) in the next year. On ultrasonography, a 1.3 × 0.6-cm-sized ovoid suspicious mass was detected in the left sternocleidomastoid muscle on the level 3 or 4 (Fig. 2). A core needle biopsy on the mass confirmed it to be parathyroid tissue. On additional sestamibi scan, a focal hot uptake was observed at the left neck (Fig. 3). Therefore, she underwent mass excision. A 1.6-cm-sized, well-circumscribed mass was detected in the sternal part of the left sternocleidomastoid muscle, excised (Fig. 4), and histologically confirmed to be parathyroid adenoma.

View Article: PubMed Central - PubMed

ABSTRACT

About 20%–30% of all cases of multiple endocrine neoplasia type 2A (MEN 2A) is accompanied by primary hyperparathyroidism. These patients undergo parathyroidectomy and, if needed, autotransplantation. In rare cases, autotransplanted parathyroid tissues can cause hypoparathyroidism due to failure of transplantation or hyperparathyroidism due to proliferation of the transplanted tissue. A 68-year-old female with MEN 2A underwent left adrenalectomy for pheochromocytoma 15 years prior to presentation and total thyroidectomy, central and right lateral neck lymph node dissection, and subtotal parathyroidectomy with autotransplantation for medullary thyroid cancer and primary hyperparathyroidism 6 years previous. Recently, a doubtful parathyroid adenoma was detected in the left sternocleidomastoid muscle on ultrasonography and on an additional sestamibi scan. The mass was excised and histologically confirmed as parathyroid adenoma. This is a very rare case, and it suggests that long-term regular monitoring of serum calcium and intact parathyroid hormone levels is necessary after parathyroid autotransplantation.

No MeSH data available.


Related in: MedlinePlus